APHDR Data Sets

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Overview

1.Cover Letter
2.Summary By Table
3.USAPHC-MEDPROS_DMSS Atr

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Sheet 1: 1.Cover Letter

This tab, 1.Cover Letter, descripes the information in tab 2.DAMIS-CHPPM Atr
Tab		Description
2.Summary By Table		Summary report of the number of attributes that are in each of the 6 tables.
3.CHPPM-MEDPROS_DMSS Atr		Report on the attributes that NIMH can selected. Explaination of the report column heads appears below, titled Column Definitions.
	Column Definitions
Column	Name	Description
A	Source	Name of Data Source
B	TabOrd	Ordinal Position of Table in Data Dictionary received from Source System-used internally
C	SourceTable	Name of the Table from which the data element is extracted from Source System
D	FieldOrd	Ordinal Position of the data element in a Table in the Source System Data Dictionary-used internally
E	FieldName	Name of the data element (please use the literal format as in the column)
F	CHPPM APPROVAL	CHPPM has accepted this as a valid element for their use-drop down list-Yes or No
G	CHPPM SP2Delta	Date the data elements requested in Spiral-2. This will help in revising your existing extract routines
H	FieldType	This is the data type and not populated at this time. It will be whatever you have in the source Tables
I	james.pruett: the property of allowing or not allowing nulls Nullability	This is the Nullability condition and not populated at this time. It will be determined when your extract is received
J	Primary Key	Indicator if data element is a primary key (PK) or foreign key (FK) in this table
K	Title	Data Element Name
L	Desc	Dictionary meaning of the data element and enumerated values if applicable
M	Values	Values the attribute can have
N	FDM Comments	Please add any comments that will help us understand the output extract.
O	PII/HIPPA Sensitive	Please note YES or NO if the element is PII or HIPPA sensitive for de-identification
P	ADS Comment	Please add any comments on authoritativeness
Q	Code Table Reference	Reference to code table.

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Sheet 2: 2.Summary By Table

Number of Attributes Available for Selection
by Table within Source
Source		SourceTable	Count
MEDPROS/DHA
	1	DD2900_200506	189
	2	DD2900-200801	227
	3	DD2795_199905	56
	4	DD2796_199905	59
	5	DD2796_200304	183
	6	DD2796_200801	336
			6 source tables with	1,050	attributes

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Sheet 3: 3.USAPHC-MEDPROS_DMSS Atr

Source

Source Tab Ord

SourceTable

Source Field Ord

FieldName

CHPPM Approval

CHPPM SP2Delta

FieldType

james.pruett: the property of allowing or not allowing nulls Nullability

james.pruett: The primary key of a relational table uniquely identifies each record in the table. It can either be a normal attribute that is guaranteed to be unique (such as Social Security Number in a table with no more than one record per person) or it can be generated by the DBMS (such as a globally unique identifier, or GUID, in Microsoft SQL Server). Primary keys may consist of a single attribute or multiple attributes in combination Primary Key

Title

Desc

Values

FDM Comments

PII/HIPAA Sensitive

ADS Comment

Code Table Reference

MEDPROS/DMSS

1

DD2900_200506

1

FORM_TYPE

Yes

CHAR(5)

N

PK

Type of Form

PDHRA

MEDPROS/DMSS

1

DD2900_200506

2

FORM_VERSION

Yes

CHAR(15)

N

PK

DOD Form Number

DD2900_200506

MEDPROS/DMSS

1

DD2900_200506

3

SSN

Yes

CHAR(9)

N

PK

Social Security Number

999999999

DI

MEDPROS/DMSS

1

DD2900_200506

4

LNAME

Yes

CHAR(25)

N

Last Name

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

5

FNAME

Yes

CHAR(15)

N

First Name

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

6

MI

Yes

CHAR(1)

Y

Middle Initial

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

7

D_EVENT

Yes

CHAR(8)

N

FK

Today's Date (date on form)

YYYYMMDD FORMAT

MEDPROS/DMSS

1

DD2900_200506

8

DOB

Yes

CHAR(8)

N

FK

Date of Birth

YYYYMMDD FORMAT

MEDPROS/DMSS

1

DD2900_200506

9

D_ARRIVAL

Yes

CHAR(8)

N

FK

Date of arrival in theater

YYYYMMDD FORMAT

MEDPROS/DMSS

1

DD2900_200506

10

D_DEPART

Yes

CHAR(8)

N

FK

Date of departure from theater

YYYYMMDD FORMAT

MEDPROS/DMSS

1

DD2900_200506

11

SEX

Yes

CHAR(1)

N

FK

Sex

M = MALE, F = FEMALE

MEDPROS/DMSS

1

DD2900_200506

12

SERVICE

Yes

CHAR(1)

N

FK

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, Z = OTHER/UNKNOWN

MEDPROS/DMSS

1

DD2900_200506

13

STATUS_PRIOR

Yes

CHAR(1)

N

FK

Status prior to deployment

0 = Active Duty, 1 = Selected Reserves - Reserve - Unit, 2 = Selected Reserves - Reserve - AGR, 3 = Selected Reserves - Reserve - IMA, 4 = Selected Reserves - National Guard - Unit, 5 =Selected Reserves - National Guard - AGR, 6 = Ready Reserves - IRR, 7

MEDPROS/DMSS

1

DD2900_200506

14

GRADE

Yes

CHAR(3)

N

FK

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O01, O02 = 002, O03 = O03, O04 = O04, O05 = O05, O06 = O06, O07 = O07, O08 = O08, O09 = O09, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER

DI

MEDPROS/DMSS

1

DD2900_200506

15

MAR_STAT

Yes

CHAR(1)

N

FK

Marital Status

0 = Never Married, 1 = Married, 2 = Separated, 3 = Divorced, 4 = Widowed

MEDPROS/DMSS

1

DD2900_200506

16

IRAQ

Yes

CHAR(1)

Y

FK

IRAQ recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

17

AFGHAN

Yes

CHAR(1)

Y

FK

AFGHAN recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

18

KUWAIT

Yes

CHAR(1)

Y

FK

KUWAIT recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

19

QATAR

Yes

CHAR(1)

Y

FK

QATAR recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

20

BOSNIA/KOSOVO

Yes

CHAR(1)

Y

FK

BOS/KOS recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

21

SWA

Yes

CHAR(1)

Y

FK

SWA recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

22

AFRICA

Yes

CHAR(1)

Y

FK

AFRICA recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

23

SO_AMER

Yes

CHAR(1)

Y

FK

SO_AMER recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

24

NO_AMER

Yes

CHAR(1)

Y

FK

NO_AMER recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

25

AUSTR

Yes

CHAR(1)

Y

FK

AUSTR recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

26

EUROPE

Yes

CHAR(1)

Y

FK

EUROPE recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

27

SHIP

Yes

CHAR(1)

Y

FK

SHIP recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

28

LOC_OTHER

Yes

CHAR(1)

Y

FK

OTHER recent deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

29

LOC_OTHER_TEXT

Yes

CHAR(15)

Y

Other Text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

30

STATUS_CURRENT

Yes

CHAR(1)

Y

FK

Status since return

0 = Maintained/returned to previous status, 1 = Transitioned to Selected Reserves, 2 = Transitioned to Ready Reserves, 3 = Retired from Military Service, 4 = Separated from Military Service

MEDPROS/DMSS

1

DD2900_200506

31

SEL_RES_TEXT

Yes

CHAR(15)

Y

Selected Reserve Text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

32

RDY_RES_TEXT

Yes

CHAR(15)

Y

Ready Reserve Text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

33

OIF_TOTAL

Yes

CHAR(1)

Y

FK

OIF Total Deployments

0 = 0, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

1

DD2900_200506

34

OEF_TOTAL

Yes

CHAR(1)

Y

FK

OEF Total Deployments

0 = 0, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

1

DD2900_200506

35

OTH_TOTAL

Yes

CHAR(1)

Y

FK

Other Total Deployments

0 = 0, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

1

DD2900_200506

36

UNIT

Yes

CHAR(20)

Y

Name of Unit

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

37

LOCATION

Yes

CHAR(20)

Y

Current Assignment Location

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

38

PHONE

Yes

CHAR(20)

N

Current Phone

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

39

CELL

Yes

CHAR(20)

Y

Current Cell Phone

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

40

DSN

Yes

CHAR(20)

Y

Current DSN

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

41

EMAIL

Yes

CHAR(50)

Y

Current Email

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

42

ADDR

Yes

CHAR(60)

Y

Current Address

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

43

CITY

Yes

CHAR(25)

N

Current CITY

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

44

STATE

Yes

CHAR(2)

N

Current STATE

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

45

ZIP

Yes

CHAR(10)

N

Current ZIP Code

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

46

POC_NAME

Yes

CHAR(50)

N

POC Name

TEXT FIELD

Yes

MEDPROS/DMSS

1

DD2900_200506

47

POC_PHONE

Yes

CHAR(20)

N

POC Phone

TEXT FIELD

Yes

MEDPROS/DMSS

1

DD2900_200506

48

POC_EMAIL

Yes

CHAR(30)

Y

POC Email

TEXT FIELD

Yes

MEDPROS/DMSS

1

DD2900_200506

49

POC_ADDR

Yes

CHAR(60)

N

POC Address

TEXT FIELD

Yes

MEDPROS/DMSS

1

DD2900_200506

50

POC_CITY

Yes

CHAR(25)

N

POC CITY

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

51

POC_STATE

Yes

CHAR(2)

N

POC STATE

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

52

POC_ZIP

Yes

CHAR(10)

N

POC ZIP Code

TEXT FIELD

MEDPROS/DMSS

1

DD2900_200506

53

HEALTH_ASSESSMENT

Yes

CHAR(1)

Y

FK

Health Rating

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR

MEDPROS/DMSS

1

DD2900_200506

54

HEALTH_CHANGE

Yes

CHAR(1)

Y

FK

Health Change

0 = Much better now than before I deployed, 1 = Somewhat better now than before I deployed, 2 = About the same as before I deployed, 3 = Somewhat worse now than before I deployed, 4 = Much worse now than before I deployed

MEDPROS/DMSS

1

DD2900_200506

55

TIMES_SEEN

Yes

CHAR(1)

Y

FK

Times seen since return

0 = 0, 1 = 1, 2 = 2 - 3, 3 = 4 - 5, 4 = 6 or more

MEDPROS/DMSS

1

DD2900_200506

56

HOSPITALIZED

Yes

CHAR(1)

Y

FK

Hospitalizations since Return

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

57

INJURED

Yes

CHAR(1)

Y

FK

Wounded, Injured or Assaulted during deployment

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

58

INJ_PROB

Yes

CHAR(1)

Y

FK

Current problems related to being Wounded, Injured or Assaulted during deployment

Y = YES, N = NO, Z = Unsure

MEDPROS/DMSS

1

DD2900_200506

59

MED_PROBLEMS

Yes

CHAR(1)

Y

FK

Health concern/condition related to deployment

Y = YES, N = NO, Z = Unsure

MEDPROS/DMSS

1

DD2900_200506

60

COUGH

Yes

CHAR(1)

Y

FK

Has concern - COUGH

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

61

RUNNY_NOSE

Yes

CHAR(1)

Y

FK

Has concern - RUNNY_NOSE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

62

FEVER

Yes

CHAR(1)

Y

FK

Has concern - FEVER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

63

WEAKNESS

Yes

CHAR(1)

Y

FK

Has concern - WEAKNESS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

64

HEADACHE

Yes

CHAR(1)

Y

FK

Has concern - HEADACHE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

65

JOINTS

Yes

CHAR(1)

Y

FK

Has concern - JOINTS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

66

BACK_PAIN

Yes

CHAR(1)

Y

FK

Has concern - BACK_PAIN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

67

MUSCLE

Yes

CHAR(1)

Y

FK

Has concern - MUSCLE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

68

NUMBNESS

Yes

CHAR(1)

Y

FK

Has concern - NUMBNESS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

69

RASH

Yes

CHAR(1)

Y

FK

Has concern - RASH

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

70

RINGING

Yes

CHAR(1)

Y

FK

Has concern - RINGING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

71

TEARING

Yes

CHAR(1)

Y

FK

Has concern - TEARING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

72

VISION

Yes

CHAR(1)

Y

FK

Has concern - VISION

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

73

CHEST_PAIN

Yes

CHAR(1)

Y

FK

Has concern - CHEST_PAIN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

74

DIZZY

Yes

CHAR(1)

Y

FK

Has concern - DIZZY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

75

BREATHING

Yes

CHAR(1)

Y

FK

Has concern - BREATHING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

76

DIARRHEA

Yes

CHAR(1)

Y

FK

Has concern - DIARRHEA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

77

TIRED

Yes

CHAR(1)

Y

FK

Has concern - TIRED

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

78

MEMORY

Yes

CHAR(1)

Y

FK

Has concern - MEMORY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

79

IRRITABLE

Yes

CHAR(1)

Y

FK

Has concern - IRRITABLE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

80

RISKY

Yes

CHAR(1)

Y

FK

Has concern - RISKY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

81

OTHER_COND

Yes

CHAR(1)

Y

FK

Has concern - OTHER_COND

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

82

OTHER_COND_TEXT

Yes

CHAR(50)

Y

Other Text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

83

EXPOSURE_CONCERNS

Yes

CHAR(1)

Y

FK

Exposure Concerns

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

84

EXP_DEET

Yes

CHAR(1)

Y

FK

Exposed to DEET

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

85

EXP_PEST_UNIFORM

Yes

CHAR(1)

Y

FK

Exposed to pesticide treated uniforms

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

86

EXP_PEST_ENVIRO

Yes

CHAR(1)

Y

FK

Exposed to environmental pesticides

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

87

EXP_FLEA

Yes

CHAR(1)

Y

FK

Exposed to flea or tick collars

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

88

EXP_PEST_STRIP

Yes

CHAR(1)

Y

FK

Exposed to pesticide strips

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

89

EXP_SMOKE_OIL

Yes

CHAR(1)

Y

FK

Exposed to smoke from oil fires

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

90

EXP_SMOKE_TRASH

Yes

CHAR(1)

Y

FK

Exposed to smoke from burning trash or feces

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

91

EXP_FUMES_EXHAUST

Yes

CHAR(1)

Y

FK

Exposed to vehicle or truch exhaust fumes

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

92

EXP_SMOKE_HEATER

Yes

CHAR(1)

Y

FK

Exposed to tent heater smoke

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

93

EXP_FUELS

Yes

CHAR(1)

Y

FK

Exposed to JP8 or other fuels

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

94

EXP_FOG_OILS

Yes

CHAR(1)

Y

FK

Exposed to fog oils

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

95

EXP_SOLVENTS

Yes

CHAR(1)

Y

FK

Exposed to solvents

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

96

EXP_PAINTS

Yes

CHAR(1)

Y

FK

Exposed to paints

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

97

EXP_RADIATION

Yes

CHAR(1)

Y

FK

Exposed to ionizing radiation

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

98

EXP_MICROWAVE

Yes

CHAR(1)

Y

FK

Exposed to radar/microwave

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

99

EXP_LASER

Yes

CHAR(1)

Y

FK

Exposed to lasers

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

100

EXP_NOISE

Yes

CHAR(1)

Y

FK

Exposed to loud noises

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

101

EXP_VIBRATION

Yes

CHAR(1)

Y

FK

Exposed to excessive vibration

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

102

EXP_POLLUTION

Yes

CHAR(1)

Y

FK

Exposed to industrial pollution

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

103

EXP_SAND

Yes

CHAR(1)

Y

FK

Exposed to sand/dust

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

104

EXP_BLAST

Yes

CHAR(1)

Y

FK

Exposed to Blast/MVA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

105

EXP_URANIUM

Yes

CHAR(1)

Y

FK

Exposted to depleted uranium

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

106

EXP_URANIUM_TEXT

Yes

CHAR(15)

Y

Explanation of exposure to depleted uranium

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

107

EXP_OTHER

Yes

CHAR(1)

Y

FK

Other exposures

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

108

EXP_OTHER_TEXT

Yes

CHAR(15)

Y

Explanation of other exposures

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

109

CONFLICTS

Yes

CHAR(1)

Y

FK

Thoughts or concerns about serious conflicts with spouse, family, or friends

Y = YES, N = NO, Z = UNSURE

MEDPROS/DMSS

1

DD2900_200506

110

NIGHTMARES

Yes

CHAR(1)

Y

FK

Past month had nightmares or thoughts when Did not want to

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

111

AVOID_SITUATIONS

Yes

CHAR(1)

Y

FK

Past month, tried hard NOT to think about it or avoided situations

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

112

ON_GUARD

Yes

CHAR(1)

Y

FK

Past month, constantly on guard, watchful or easily startled

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

113

DETACHED

Yes

CHAR(1)

Y

FK

Past month, felt numb, detached from others, activities, or surroundings

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

114

ETOH

Yes

CHAR(1)

Y

FK

Use Alcohol more than meant to

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

115

ETOH_DOWN

Yes

CHAR(1)

Y

FK

Felt or wanted to cut down alcohol consupmtion

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

116

LITTLE_INTEREST

Yes

CHAR(1)

Y

FK

Over past month had little interest or pleasure in doing things

0 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day

MEDPROS/DMSS

1

DD2900_200506

117

FEELING_DOWN

Yes

CHAR(1)

Y

FK

Over past month feeling down, depressed, or hopeless

0 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day

MEDPROS/DMSS

1

DD2900_200506

118

DIFFICULTY

Yes

CHAR(1)

Y

FK

Difficulty at work, home or people

0 = Not difficult at all, 1 = Somewhat difficult, 2 = Very difficult, 3 = Extremely difficult

MEDPROS/DMSS

1

DD2900_200506

119

REQ_PROVIDER

Yes

CHAR(1)

Y

FK

Would like to schedule healthcare visit

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

120

REQ_STRESS

Yes

CHAR(1)

Y

FK

Interested receiving info for stress

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

121

REQ_FAMILY

Yes

CHAR(1)

Y

FK

Interested in assistance with Family

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

122

REQ_CHAPLAIN

Yes

CHAR(1)

Y

FK

Interesrted in seeing Chaplain

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

123

PROVIDER_REVIEW

Yes

CHAR(1)

Y

FK

Review symptoms or concerns

0 = confirmed, 1 = modified

MEDPROS/DMSS

1

DD2900_200506

124

PROV_REV_TEXT

Yes

CHAR(100)

Y

Provider review modified text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

125

HURT_SELF

Yes

CHAR(1)

Y

FK

Over last month, thoughts that you would be better off dead or hurting yourself in some way.

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

126

HURT_SELF_FREQ

Yes

CHAR(1)

Y

FK

How often bothered by thoughts that you would be better off dead or hurting yourself in some way.

0 = A few days, 1 = More than half of the time, 2 = Nearly every day

MEDPROS/DMSS

1

DD2900_200506

127

LOSE_CONTROL

Yes

CHAR(1)

Y

FK

Thoughts or concerns about hurting or losing control with someone

Y = YES, N = NO, Z = UNSURE

MEDPROS/DMSS

1

DD2900_200506

128

CURRENT_RISK

Yes

CHAR(1)

Y

FK

Provider determined risk

Y = YES, N = NO, Z = UNSURE

MEDPROS/DMSS

1

DD2900_200506

129

OUTCOME

Yes

CHAR(1)

Y

FK

Outcome of Assessment

0 = Immediate referral, 1 = Routine follow-up referral, 2 = Referral not indicated

MEDPROS/DMSS

1

DD2900_200506

130

PT_CONCERNS_TEXT

Yes

CHAR(100)

Y

Patient concerns identified by Provider

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

131

CON_NONE

Yes

CHAR(1)

Y

FK

Identified concern for NONE

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

132

CON_PHYSICAL

Yes

CHAR(1)

Y

FK

Identified concern for PHYSICAL

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

133

CON_EXPOSURE

Yes

CHAR(1)

Y

FK

Identified concern for EXP

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

134

CON_DEPRESSION

Yes

CHAR(1)

Y

FK

Identified concern for DEPRESSION

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

135

CON_PTSD

Yes

CHAR(1)

Y

FK

Identified concern for PTSD

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

136

CON_ANGER

Yes

CHAR(1)

Y

FK

Identified concern for ANGER

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

137

CON_SUICIDE

Yes

CHAR(1)

Y

FK

Identified concern for SUICIDE

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

138

CON_FAMILY

Yes

CHAR(1)

Y

FK

Identified concern for FAMILY

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

139

CON_ETOH

Yes

CHAR(1)

Y

FK

Identified concern for ETOH

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

140

CON_OTHER

Yes

CHAR(1)

Y

FK

Identified concern for OTHER

0 = minor, 1 = major

MEDPROS/DMSS

1

DD2900_200506

141

CON_OTHER_TEXT

Yes

CHAR(15)

Y

Concerns Other Text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

142

CARE_PHYSICAL

Yes

CHAR(1)

Y

FK

Under care for PHYSICAL

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

143

CARE_EXPOSURE

Yes

CHAR(1)

Y

FK

Under care for EXP

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

144

CARE_DEPRESSION

Yes

CHAR(1)

Y

FK

Under care for DEPRESSION

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

145

CARE_PTSD

Yes

CHAR(1)

Y

FK

Under care for PTSD

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

146

CARE_ANGER

Yes

CHAR(1)

Y

FK

Under care for ANGER

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

147

CARE_SUICIDE

Yes

CHAR(1)

Y

FK

Under care for SUICIDE

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

148

CARE_FAMILY

Yes

CHAR(1)

Y

FK

Under care for FAMILY

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

149

CARE_ETOH

Yes

CHAR(1)

Y

FK

Under care for ETOH

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

150

CARE_OTHER

Yes

CHAR(1)

Y

FK

Under care for OTHER

Y = YES, N = NO

MEDPROS/DMSS

1

DD2900_200506

151

REF_NONE

Yes

CHAR(1)

Y

FK

Ref info for NONE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

152

REF_URGENT

Yes

CHAR(1)

Y

FK

Ref info for URGENT

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

153

REF_PRIMARY

Yes

CHAR(1)

Y

FK

Ref info for PRIMARY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

154

REF_SPECIALTY

Yes

CHAR(1)

Y

FK

Ref info for SPECIALTY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

155

REF_SPEC_TEXT

Yes

CHAR(15)

Y

REF Specialty Care text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

156

REF_MENTAL_PRIMARY

Yes

CHAR(1)

Y

FK

Ref info for MENTAL_PRIMARY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

157

REF_MENTAL_SPECIAL

Yes

CHAR(1)

Y

FK

Ref info for MENTAL_SPECIAL

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

158

REF_CASE

Yes

CHAR(1)

Y

FK

Ref info for CASE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

159

REF_ABUSE

Yes

CHAR(1)

Y

FK

Ref info for ABUSE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

160

REF_HEALTH_ED

Yes

CHAR(1)

Y

FK

Ref info for PM

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

161

REF_OTH_SERVICE

Yes

CHAR(1)

Y

FK

Ref info for OTH_SERVICE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

162

REF_CHAPLAIN

Yes

CHAR(1)

Y

FK

Ref info for CHAPLAIN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

163

REF_FAMILY

Yes

CHAR(1)

Y

FK

Ref info for FAMILY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

164

REF_ONE_SOURCE

Yes

CHAR(1)

Y

FK

Ref info for ONE_SOURCE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

165

REF_OTHER

Yes

CHAR(1)

Y

FK

Ref info for OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

166

REF_OTHER_TEXT

Yes

CHAR(15)

Y

REF Other text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

167

PROVIDER_COMMENTS

Yes

CHAR(200)

Y

Comments

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

168

CERT_PROVIDER

Yes

CHAR(1)

Y

FK

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

1

DD2900_200506

169

D_CERT_PROVIDER

Yes

CHAR(8)

Y

FK

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

1

DD2900_200506

170

PROV_HEALTH_ED

Yes

CHAR(1)

Y

FK

Provided info for Health ED

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

171

PROV_BENEFIT

Yes

CHAR(1)

Y

FK

Provided info for Benefits

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

172

PROV_APPT

Yes

CHAR(1)

Y

FK

Provided info for Appointments

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

173

DECLINED_FORM

Yes

CHAR(1)

Y

FK

Member Declined form

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

174

DECLINED_INTERVIEW

Yes

CHAR(1)

Y

FK

Member Declined Interview

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

175

DECLINED_REFERRAL

Yes

CHAR(1)

Y

FK

Member Declined referral

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

176

PROV_OTHER

Yes

CHAR(1)

Y

FK

Provided OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

177

PROV_OTHER_TEXT

Yes

CHAR(15)

Y

Provided OTHER_TEXT

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

178

SYS_MTF

Yes

CHAR(1)

Y

FK

Referred to MTF

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

179

SYS_DIV

Yes

CHAR(1)

Y

FK

Referred to Division/Line

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

180

SYS_VA

Yes

CHAR(1)

Y

FK

Referred to VA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

181

SYS_VET

Yes

CHAR(1)

Y

FK

Referred to Vet

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

182

SYS_TRICARE

Yes

CHAR(1)

Y

FK

Referred to TRICARE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

183

SYS_CONTRACT

Yes

CHAR(1)

Y

FK

Referred to Contractor

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

184

SYS_CONTRACT_TEXT

Yes

CHAR(15)

Y

Referred to Contractor text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

185

SYS_CMNTY

Yes

CHAR(1)

Y

FK

Referred to COMMUNITY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

186

SYS_CMNTY_TEXT

Yes

CHAR(15)

Y

Referred to COMMUNITY text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

187

SYS_OTHER

Yes

CHAR(1)

Y

FK

Referred to OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

1

DD2900_200506

188

SYS_OTHER_TEXT

Yes

CHAR(15)

Y

Referred to OTHER text

TEXT FIELD

yes

MEDPROS/DMSS

1

DD2900_200506

189

SYS_NONE

Yes

CHAR(1)

Y

FK

Referred to NONE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

1

FORM_TYPE

Yes

Char(5)

N

PK

Type of Form

PDHRA

MEDPROS/DMSS

2

DD2900-200801

2

FORM_VERSION

Yes

Char(15)

N

PK

DOD Form Number

DD2900_200801

MEDPROS/DMSS

2

DD2900-200801

3

SSN

Yes

Char(9)

N

PK

Social Security Number

NNNNNNNNN

DI

MEDPROS/DMSS

2

DD2900-200801

4

LNAME

Yes

Char(25)

Y

Last Name

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

5

FNAME

Yes

Char(15)

Y

First Name

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

6

MI

Yes

Char(1)

Y

Middle Initial

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

7

D_EVENT

Yes

Char(8)

N

FK

Today's Date (date on form)

YYYYMMDD, <=SYSDATE

MEDPROS/DMSS

2

DD2900-200801

8

DOB

Yes

Char(8)

N

FK

Date of Birth

YYYYMMDD, <=SYSDATE

MEDPROS/DMSS

2

DD2900-200801

9

D_ARRIVAL

Yes

Char(8)

N

FK

Date of arrival in theater

YYYYMMDD <= SYSDATE and D_DEPART

MEDPROS/DMSS

2

DD2900-200801

10

D_DEPART

Yes

Char(8)

N

FK

Date of departure from theater

YYYYMMDD, >= D_ARRIVAL

MEDPROS/DMSS

2

DD2900-200801

11

SEX

Yes

Char(1)

Y

FK

Gender

M=Male, F=female, blank=not marked

MEDPROS/DMSS

2

DD2900-200801

12

SERVICE

Yes

Char(1)

Y

FK

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, X=CIVILIAN/GS, Z = OTHER, Blank=Not marked

MEDPROS/DMSS

2

DD2900-200801

13

STATUS_PRIOR

Yes

Char(1)

Y

FK

Status prior to deployment

0 = Active Duty, 1 = Selected Reserves - Reserve - Unit, 2 = Selected Reserves - Reserve - AGR, 3 = Selected Reserves - Reserve - IMA, 4 = Selected Reserves - National Guard - Unit, 5 =Selected Reserves - National Guard - AGR, 6 = Ready Reserves - IRR, 7=Ready Reserves - ING 8= Civilian, 9= Other, blank = not completed

MEDPROS/DMSS

2

DD2900-200801

14

GRADE

Yes

Char(3)

Y

FK

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O1, O02 = 02, O03 = O3, O04 = O4, O05 = O5, O06 = O6, O07 = O7, O08 = O8, O09 = O9, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER, Blank=Not marked

DI

MEDPROS/DMSS

2

DD2900-200801

15

MAR_STAT_2900

Yes

Char(1)

N

FK

Marital Status

0 = Never Married, 1 = Married, 2 = Separated, 3 = Divorced, 4 = Widowed

MEDPROS/DMSS

2

DD2900-200801

16

COUNTRY1

Yes

Char(2)

N

FK

Country 1

Two character FIPS 10 country code

MEDPROS/DMSS

2

DD2900-200801

17

COUNTRY1_MONTHS

Yes

Char(2)

N

FK

Months in country 1

NN

MEDPROS/DMSS

2

DD2900-200801

18

COUNTRY2

Yes

Char(2)

Y

FK

Country 2

Two character FIPS 10 country code

MEDPROS/DMSS

2

DD2900-200801

19

COUNTRY2_MONTHS

Yes

Char(2)

Y

FK

Months in country 2

NN

MEDPROS/DMSS

2

DD2900-200801

20

COUNTRY3

Yes

Char(2)

Y

FK

Country 3

Two character FIPS 10 country code

MEDPROS/DMSS

2

DD2900-200801

21

COUNTRY3_MONTHS

Yes

Char(2)

Y

FK

Months in country 3

NN

MEDPROS/DMSS

2

DD2900-200801

22

COUNTRY4

Yes

Char(2)

Y

FK

Country 4

Two character FIPS 10 country code

MEDPROS/DMSS

2

DD2900-200801

23

COUNTRY4_MONTHS

Yes

Char(2)

Y

FK

Months in country 4

NN

MEDPROS/DMSS

2

DD2900-200801

24

COUNTRY5

Yes

Char(2)

Y

FK

Country 5

Two character FIPS 10 country code

MEDPROS/DMSS

2

DD2900-200801

25

COUNTRY5_MONTHS

Yes

Char(2)

Y

FK

Months in country 5

NN

MEDPROS/DMSS

2

DD2900-200801

26

STATUS_CURRENT

Yes

Char(1)

Y

FK

Status since return

0 = Maintained/returned to previous status, 1 = Transitioned to Selected Reserves, 2 = Transitioned to IRR, 3= Transitioned to ING, 4 = Retired from Military Service, 5 = Separated from Military Service

MEDPROS/DMSS

2

DD2900-200801

27

OIF_TOTAL

Yes

Char(1)

N

FK

OIF Total Deployments

0 = Not Checked, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

2

DD2900-200801

28

OEF_TOTAL

Yes

Char(1)

N

FK

OEF Total Deployments

0 = Not Checked, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

2

DD2900-200801

29

OTH_TOTAL

Yes

Char(1)

N

FK

Other Total Deployments

0 = Not Checked, 1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5 or more

MEDPROS/DMSS

2

DD2900-200801

30

UNIT

Yes

Char(20)

Y

Name of Unit

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

31

CURR_LOCATION

Yes

Char(20)

Y

Current Assignment Location

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

32

PHONE

Yes

Char(20)

Y

Current Phone

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

33

CELL

Yes

Char(20)

Y

Current Cell Phone

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

34

DSN

Yes

Char(20)

Y

Current DSN

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

35

EMAIL

Yes

Char(50)

Y

Current Email

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

36

ADDR

Yes

Char(60)

Y

Current Address

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

37

CITY

Yes

Char(25)

Y

Current CITY

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

38

STATE

Yes

Char(2)

Y

Current STATE

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

39

ZIP

Yes

Char(10)

Y

Current ZIP Code

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

40

POC_NAME

Yes

Char(50)

Y

POC Name

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

41

POC_PHONE

Yes

Char(20)

Y

POC Phone

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

42

POC_EMAIL

Yes

Char(50)

Y

POC Email

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

43

POC_ADDR

Yes

Char(60)

Y

POC Address

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

44

POC_CITY

Yes

Char(25)

Y

POC CITY

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

45

POC_STATE

Yes

Char(2)

Y

POC STATE

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

46

POC_ZIP

Yes

Char(10)

Y

POC ZIP Code

TEXT FIELD

MEDPROS/DMSS

2

DD2900-200801

47

HEALTH_ASSESSMENT

Yes

Char(1)

Y

FK

How wold you rate your health during the past month:

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

48

HEALTH_CHANGE

Yes

Char(1)

Y

FK

Compared to before this deployment, how would you ratre your health in general now??

0 = Much better now than before I deployed, 1 = Somewhat better now than before I deployed, 2 = About the same as before I deployed, 3 = Somewhat worse now than before I deployed, 4 = Much worse now than before I deployed, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

49

DIFF_PHYSICAL

Yes

Char(1)

Y

FK

During the past 4 weeks, how difficult have health problems made it to do your work?

N = not difficult at all, S = somewhat difficult, V = very difficult, E = extremely difficult, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

50

DIFF_EMOTIONAL

Yes

Char(1)

Y

FK

During the past 4 weeks, how difficult have emotional problems made it to do your work?

N = not difficult at all, S = somewhat difficult, V = very difficult, E = extremely difficult, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

51

TIMES_SEEN_AFTER

Yes

Char(1)

Y

FK

Times seen since return

0 = 0, 1 = 1, 2 = 2 - 3, 3 = 4 - 5, 4 = 6 or more, blank=not completed

MEDPROS/DMSS

2

DD2900-200801

52

HOSPITALIZED_AFTER

Yes

Char(1)

Y

FK

Hospitalizations since Return

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

53

INJURED

Yes

Char(1)

Y

FK

Wounded, Injured or Assaulted during deployment

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

54

INJ_PROB

Yes

Char(1)

Y

FK

Current problems related to being Wounded, Injured or Assaulted during deployment

Y = YES, N = NO, Z = Unsure, blank=not completed

MEDPROS/DMSS

2

DD2900-200801

55

HEALTH_CONCERNS

Yes

Char(1)

Y

FK

Health concern/condition related to deployment

Y = YES, N = NO, Z = Unsure, blank=not completed

MEDPROS/DMSS

2

DD2900-200801

56

FEVER

Yes

Char(1)

N

FK

Has concern - FEVER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

57

COUGH

Yes

Char(1)

N

FK

Has concern - COUGH

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

58

BREATHING

Yes

Char(1)

N

FK

Has concern - BREATHING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

59

HEADACHE

Yes

Char(1)

N

FK

Has concern - HEADACHE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

60

WEAKNESS

Yes

Char(1)

N

FK

Has concern - WEAKNESS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

61

MUSCLE

Yes

Char(1)

N

FK

Has concern - MUSCLE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

62

JOINTS

Yes

Char(1)

N

FK

Has concern - JOINTS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

63

BACK_PAIN

Yes

Char(1)

N

FK

Has concern - BACK_PAIN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

64

NUMBNESS

Yes

Char(1)

N

FK

Has concern - NUMBNESS

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

65

HEARING

Yes

Char(1)

N

FK

Has concern - Hearing

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

66

RINGING

Yes

Char(1)

N

FK

Has concern - RINGING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

67

TEARING

Yes

Char(1)

N

FK

Has concern - TEARING

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

68

VISION

Yes

Char(1)

N

FK

Has concern - VISION

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

69

CHEST_PAIN

Yes

Char(1)

N

FK

Has concern - CHEST_PAIN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

70

DIZZY

Yes

Char(1)

N

FK

Has concern - DIZZY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

71

DIARRHEA

Yes

Char(1)

N

FK

Has concern - DIARRHEA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

72

TIRED

Yes

Char(1)

N

FK

Has concern - TIRED

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

73

CONCENTRATION

Yes

Char(1)

N

FK

Has concern - Concentration

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

74

MEMORY

Yes

Char(1)

N

FK

Has concern - MEMORY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

75

DECISION

Yes

Char(1)

N

FK

Has concern - indecisive

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

76

IRRITABLE

Yes

Char(1)

N

FK

Has concern - IRRITABLE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

77

RISK_TAKING

Yes

Char(1)

N

FK

Has concern - RISKY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

78

RASH

Yes

Char(1)

N

FK

Has concern - RASH

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

79

OTHER_COND

Yes

Char(1)

N

FK

Has concern - OTHER_COND

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

80

OTHER_COND_TEXT

Yes

Char(50)

Y

Other Text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

81

EXP_BLAST

Yes

Char(1)

N

FK

Exposed to Blast

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

82

EXP_CRASH

Yes

Char(1)

N

FK

Exposed to MVA

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

83

EXP_WOUND

Yes

Char(1)

N

FK

Exposed to Frag/Bullet wound

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

84

EXP_FALL

Yes

Char(1)

N

FK

Exposed to Fall

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

85

EXP_OTHER_INJ

Yes

Char(1)

N

FK

Exposed to other injury

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

86

EXP_OTHER_INJ_TEXT

Yes

Char(30)

Y

Exposed to other injury

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

87

IMMED_LOC

Yes

Char(1)

N

FK

Immediate onset LOC (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

88

IMMED_DAZED

Yes

Char(1)

N

FK

Immediate onset Dazed (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

89

IMMED_MEMORY

Yes

Char(1)

N

FK

Immediate onset Memory Loss (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

90

IMMED_CONCUSSION

Yes

Char(1)

N

FK

Immediate onset Concussion (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

91

IMMED_HEAD_INJ

Yes

Char(1)

N

FK

Immediate onset Head injury (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

92

POST_LAPSES

Yes

Char(1)

N

FK

Post event memory lapse (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

93

POST_DIZZY

Yes

Char(1)

N

FK

Post event dizzy (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

94

POST_RINGING

Yes

Char(1)

N

FK

Post event ringing (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

95

POST_PHOTOSENS

Yes

Char(1)

N

FK

Post event photosensitivity (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

96

POST_IRRITABLE

Yes

Char(1)

N

FK

Post event irritabillity (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

97

POST_HEADACHE

Yes

Char(1)

N

FK

Post event headaches (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

98

POST_SLEEP

Yes

Char(1)

N

FK

Post event sleep problems (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

99

WEEK_MEMORY

Yes

Char(1)

N

FK

Past week memory lapse (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

100

WEEK_DIZZY

Yes

Char(1)

N

FK

Past week dizzy (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

101

WEEK_RINGING

Yes

Char(1)

Y

FK

Past week ringing (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

102

WEEK_PHOTOSENS

Yes

Char(1)

Y

FK

Past week photosensitivity (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

103

WEEK_IRRITABLE

Yes

Char(1)

Y

FK

Past week irritabillity (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

104

WEEK_HEADACHE

Yes

Char(1)

Y

FK

Past week headaches (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

105

WEEK_SLEEP

Yes

Char(1)

Y

FK

Past week sleep problems (TBI)

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

106

EXPOSURE_CONCERNS

Yes

Char(1)

Y

FK

Exposure Concerns

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

107

EXP_ANIMAL_BITES

Yes

Char(1)

N

FK

Exposed to animal bites

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

108

EXP_ANIMAL_BODIES

Yes

Char(1)

N

FK

Exposed to animal bodies

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

109

EXP_CHLORINE

Yes

Char(1)

N

FK

Exposed to chlorine gas

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

110

EXP_URANIUM

Yes

Char(1)

N

FK

Exposed to depleted uranium

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

111

EXP_URANIUM_TEXT

Yes

Char(15)

Y

Explanation of exposure to depleted uranium

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

112

EXP_VIBRATION

Yes

Char(1)

N

FK

Exposed to excessive vibration

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

113

EXP_FOG_OILS

Yes

Char(1)

N

FK

Exposed to fog oils

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

114

EXP_GARBAGE

Yes

Char(1)

N

FK

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

115

EXP_HUMAN_BODIES

Yes

Char(1)

N

FK

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

116

EXP_POLLUTION

Yes

Char(1)

N

FK

Exposed to industrial pollution

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

117

EXP_INSECT_BITES

Yes

Char(1)

N

FK

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

118

EXP_RADIATION

Yes

Char(1)

N

FK

Exposed to ionizing radiation

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

119

EXP_FUELS

Yes

Char(1)

N

FK

Exposed to JP8 or other fuels

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

120

EXP_LASER

Yes

Char(1)

N

FK

Exposed to lasers

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

121

EXP_NOISE

Yes

Char(1)

N

FK

Exposed to loud noises

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

122

EXP_PAINTS

Yes

Char(1)

N

FK

Exposed to paints

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

123

EXP_PEST_ENVIRO

Yes

Char(1)

N

FK

Exposed to environmental pesticides

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

124

EXP_MICROWAVE

Yes

Char(1)

N

FK

Exposed to radar/microwave

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

125

EXP_SAND

Yes

Char(1)

N

FK

Exposed to sand/dust

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

126

EXP_SMOKE_TRASH

Yes

Char(1)

N

FK

Exposed to smoke from burning trash or feces

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

127

EXP_SMOKE_OIL

Yes

Char(1)

N

FK

Exposed to smoke from oil fires

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

128

EXP_SOLVENTS

Yes

Char(1)

N

FK

Exposed to solvents

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

129

EXP_SMOKE_HEATER

Yes

Char(1)

N

FK

Exposed to tent heater smoke

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

130

EXP_FUMES_EXHAUST

Yes

Char(1)

N

FK

Exposed to vehicle or truch exhaust fumes

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

131

EXP_OTHER

Yes

Char(1)

N

FK

Other exposures

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

132

EXP_OTHER_TEXT

Yes

Char(15)

Y

Explanation of other exposures

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

133

CONFLICTS

Yes

Char(1)

Y

FK

Thoughts or concerns about serious conflicts with spouse, family, or friends

Y = YES, N = NO, Z = Unsure, blank=not completed

MEDPROS/DMSS

2

DD2900-200801

134

NIGHTMARES

Yes

Char(1)

Y

FK

Past month had nightmares or thoughts when Did not want to

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

135

AVOID_SITUATIONS

Yes

Char(1)

Y

FK

Past month, tried hard NOT to think about it or avoided situations

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

136

ON_GUARD

Yes

Char(1)

Y

FK

Past month, constantly on guard, watchful or easily startled

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

137

DETACHED

Yes

Char(1)

Y

FK

Past month, felt numb, detached from others, activities, or surroundings

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

138

ETOH

Yes

Char(1)

Y

FK

Use Alcohol more than meant to

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

139

ETOH_DOWN

Yes

Char(1)

Y

FK

Felt or wanted to cut down alcohol consumption

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

140

ETOH_OFTEN

Yes

Char(1)

Y

FK

How often do you..

0=never,1=monthly or less, 2 = 2-4 times per month,3=2-3 times per week, 4=4or more times per week, blank=not marked

MEDPROS/DMSS

2

DD2900-200801

141

ETOH_DAY

Yes

Char(1)

Y

FK

how many drink on a typical day

0=1-2,1=3-4,2=5-6,3=7-9,4=10 or more, blank=not marked

MEDPROS/DMSS

2

DD2900-200801

142

ETOH_BINGE

Yes

Char(1)

Y

FK

how often six or more drinks

0=never, 1= less than monthly, 2=monthly,3=weekly,4=daily, blank=not marked

MEDPROS/DMSS

2

DD2900-200801

143

LITTLE_INTEREST

Yes

Char(1)

Y

FK

Over past month had little interest or pleasure in doing things

0 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day, Z=blank

MEDPROS/DMSS

2

DD2900-200801

144

FEELING_DOWN

Yes

Char(1)

Y

FK

Over past month feeling down, depressed, or hopeless

0 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day, Z=blank

MEDPROS/DMSS

2

DD2900-200801

145

REQ_PROVIDER

Yes

Char(1)

Y

FK

Would like to schedule healthcare visit

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

146

REQ_STRESS

Yes

Char(1)

Y

FK

Interested receiving info for stress

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

147

REQ_FAMILY

Yes

Char(1)

Y

FK

Interested in assistance with Family

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

148

REQ_CHAPLAIN

Yes

Char(1)

Y

FK

Interesrted in seeing Chaplain

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

149

PROVIDER_REVIEW

Yes

Char(1)

Y

FK

Review symptoms or concerns

0 = confirmed, 1 = modified, blank= not checked

MEDPROS/DMSS

2

DD2900-200801

150

HEALTH_CONCERNS_TEXT

Yes

Char(100)

Y

Provider review modified text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

151

HURT_SELF

Yes

Char(1)

Y

FK

Over last month, thoughts that you would be better off dead or hurting yourself in some way.

Y = YES, N = NO, Blank=not completed

MEDPROS/DMSS

2

DD2900-200801

152

HURT_SELF_FREQ

Yes

Char(1)

Y

FK

How often bothered by thoughts that you would be better off dead or hurting yourself in some way.

0 = Very few days, 1 = More than half of the time, 2 = Nearly every day, Z=blank

MEDPROS/DMSS

2

DD2900-200801

153

LOSE_CONTROL

Yes

Char(1)

Y

FK

Thoughts or concerns about hurting or losing control with someone

Y = YES, N = NO, Z = UNSURE, null=blank

MEDPROS/DMSS

2

DD2900-200801

154

CURRENT_RISK

Yes

Char(1)

Y

FK

Provider determined risk

Y = YES, N = NO, Z = UNSURE, null=blank

MEDPROS/DMSS

2

DD2900-200801

155

OUTCOME

Yes

Char(1)

Y

FK

Outcome of Assessment

0 = Immediate referral, 1 = Routine follow-up referral, 2 = Referral not indicated, Z=blank

MEDPROS/DMSS

2

DD2900-200801

156

SCREEN_ETOH

Yes

Char(1)

Y

FK

Alchohol screening result

0=no evidence, 1=Potential ETOH problem + Refer to PCM, 2= Potential ETOH problem No PCM referral, 3=Potential ETOH Problem and referral not checked, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

157

SCREEN_TBI

Yes

Char(1)

Y

FK

Evidence of TBI problem

0=no evidence, 1=Potential TBI problem + Refer , 2= Potential TBI problem + No referral, 3=Potential TBI Problem + referral not checked, blank=TBI question not answered

MEDPROS/DMSS

2

DD2900-200801

158

PT_CONCERNS_TEXT

Yes

Char(100)

Y

Patient concerns identified by Provider

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

159

CON_PHYSICAL

Yes

Char(1)

Y

FK

Identified concern for PHYSICAL

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

160

CON_EXPOSURE

Yes

Char(1)

Y

FK

Identified concern for EXP

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

161

CON_DEPRESSION

Yes

Char(1)

Y

FK

Identified concern for DEPRESSION

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

162

CON_PTSD

Yes

Char(1)

Y

FK

Identified concern for PTSD

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

163

CON_ANGER

Yes

Char(1)

Y

FK

Identified concern for ANGER

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

164

CON_SUICIDE

Yes

Char(1)

Y

FK

Identified concern for SUICIDE

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

165

CON_FAMILY

Yes

Char(1)

Y

FK

Identified concern for FAMILY

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

166

CON_ETOH

Yes

Char(1)

Y

FK

Identified concern for ETOH

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

167

CON_OTHER

Yes

Char(1)

Y

FK

Identified concern for OTHER

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

168

CON_OTHER_TEXT

Yes

Char(15)

Y

Concerns Other Text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

169

CARE_PHYSICAL

Yes

Char(1)

Y

FK

Under care for PHYSICAL

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

170

CARE_EXPOSURE

Yes

Char(1)

Y

FK

Under care for EXP

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

171

CARE_DEPRESSION

Yes

Char(1)

Y

FK

Under care for DEPRESSION

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

172

CARE_PTSD

Yes

Char(1)

Y

FK

Under care for PTSD

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

173

CARE_ANGER

Yes

Char(1)

Y

FK

Under care for ANGER

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

174

CARE_SUICIDE

Yes

Char(1)

Y

FK

Under care for SUICIDE

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

175

CARE_FAMILY

Yes

Char(1)

Y

FK

Under care for FAMILY

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

176

CARE_ETOH

Yes

Char(1)

Y

FK

Under care for ETOH

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

177

CARE_OTHER

Yes

Char(1)

Y

FK

Under care for OTHER

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

2

DD2900-200801

178

REFTIME_PRIMARY

Yes

Char(1)

Y

FK

Ref info for PRIMARY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

179

REFTIME_MENTAL_PRIMARY

Yes

Char(1)

Y

FK

Ref info for MENTAL_PRIMARY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

180

REFTIME_MENTAL_SPECIAL

Yes

Char(1)

Y

FK

Ref info for MENTAL_SPECIAL

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

181

REFTIME_AUDIOLOGY

Yes

Char(1)

Y

FK

Referral indicated - Audiology

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

182

REFTIME_CARDIAC

Yes

Char(1)

Y

FK

Referral indicated - cardiac

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

183

REFTIME_DENTAL

Yes

Char(1)

Y

FK

Referral indicated - dental

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

184

REFTIME_DERM

Yes

Char(1)

Y

FK

Referral indicated - dermatologic

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

185

REFTIME_ENT

Yes

Char(1)

Y

FK

Referral indicated - ENT

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

186

REFTIME_GI

Yes

Char(1)

Y

FK

Referral indicated - GI

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

187

REFTIME_MED

Yes

Char(1)

Y

FK

Referal indicated - internal medicine

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

188

REFTIME_NEURO

Yes

Char(1)

Y

FK

Referral indicated - Neurologic

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

189

REFTIME_GYN

Yes

Char(1)

Y

FK

Referral indicated - GYN

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

190

REFTIME_OPTHA

Yes

Char(1)

Y

FK

Referral indicated - OPTHAL

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

191

REFTIME_OPTO

Yes

Char(1)

Y

FK

Referral indicated - OPTO

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

192

REFTIME_ORTHO

Yes

Char(1)

Y

FK

Referral indicated - Orthopedic

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

193

REFTIME_PULMONARY

Yes

Char(1)

Y

FK

Referral indicated - Pulmonary

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

194

REFTIME_GU

Yes

Char(1)

Y

FK

Referral indicated - GU

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

195

REFTIME_CASE

Yes

Char(1)

Y

FK

Ref info for CASE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

196

REFTIME_ABUSE

Yes

Char(1)

Y

FK

Ref info for ABUSE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

197

REFTIME_HEALTH_ED

Yes

Char(1)

Y

FK

Ref info for Health Promo

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

198

REFTIME_CHAPLAIN

Yes

Char(1)

Y

FK

Ref info for CHAPLAIN

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

199

REFTIME_FAMILY

Yes

Char(1)

Y

FK

Ref info for FAMILY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

200

REFTIME_ONE_SOURCE

Yes

Char(1)

Y

FK

Ref info for ONE_SOURCE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

201

REFTIME_OTHER

Yes

Char(1)

Y

FK

Ref info for OTHER

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

2

DD2900-200801

202

REF_OTHER_TEXT

Yes

Char(15)

Y

REF Other text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

203

REF_NONE

Yes

Char(1)

N

FK

no referral made

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

204

PROVIDER_COMMENTS

Yes

Char(255)

Y

Comments

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

205

CERT_PROVIDER

Yes

Char(1)

N

FK

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

2

DD2900-200801

206

D_CERT_PROVIDER

Yes

Char(8)

N

FK

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

2

DD2900-200801

207

PROV_HEALTH_ED

Yes

Char(1)

N

FK

Provided info for Health ED

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

208

PROV_BENEFIT

Yes

Char(1)

N

FK

Provided info for Benefits

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

209

PROV_APPT

Yes

Char(1)

N

FK

Provided info for Appointments

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

210

DECLINED_FORM

Yes

Char(1)

N

FK

Member Declined form

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

211

DECLINED_INTERVIEW

Yes

Char(1)

N

FK

Member Declined Interview

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

212

DECLINED_REFERRAL

Yes

Char(1)

N

FK

Member Declined referral

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

213

PROV_LOD

Yes

Char(1)

N

FK

Provided LOD

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

214

PROV_OTHER

Yes

Char(1)

N

FK

Provided OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

215

PROV_OTHER_TEXT

Yes

Char(15)

Y

Provided OTHER_TEXT

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

216

SYS_MTF

Yes

Char(1)

N

FK

Referred to MTF

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

217

SYS_DIV

Yes

Char(1)

N

FK

Referred to Division/Line

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

218

SYS_VA

Yes

Char(1)

N

FK

Referred to VA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

219

SYS_VET

Yes

Char(1)

N

FK

Referred to Vet

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

220

SYS_TRICARE

Yes

Char(1)

N

FK

Referred to TRICARE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

221

SYS_CONTRACT

Yes

Char(1)

N

FK

Referred to Contractor

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

222

SYS_CONTRACT_TEXT

Yes

Char(15)

Y

Referred to Contractor text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

223

SYS_CMNTY

Yes

Char(1)

N

FK

Referred to COMMUNITY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

224

SYS_CMNTY_TEXT

Yes

Char(15)

Y

Referred to COMMUNITY text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

225

SYS_OTHER

Yes

Char(1)

N

FK

Referred to OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

2

DD2900-200801

226

SYS_OTHER_TEXT

Yes

Char(15)

Y

Referred to OTHER text

TEXT FIELD

yes

MEDPROS/DMSS

2

DD2900-200801

227

SYS_NONE

Yes

Char(1)

N

FK

Referred to NONE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

1

FORM_TYPE

Yes

CHAR(4)

N

PK

Type of Form

PRE

MEDPROS/DMSS

3

DD2795_199905

2

FORM_VERSION

Yes

CHAR(15)

N

PK

DOD Form Number

DD2795_199905

MEDPROS/DMSS

3

DD2795_199905

3

SSN

Yes

CHAR(9)

N

PK

Social Security Number

999999999

DI

MEDPROS/DMSS

3

DD2795_199905

4

LNAME

Yes

CHAR(25)

N

Last Name

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

5

FNAME

Yes

CHAR(15)

N

First Name

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

6

MI

Yes

CHAR(1)

Y

Middle Initial

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

7

D_EVENT

Yes

CHAR(8)

N

FK

Today's Date (date on form)

YYYYMMDD FORMAT

MEDPROS/DMSS

3

DD2795_199905

8

DEPLOYING_UNIT

Yes

CHAR(20)

y

Name of Unit or Ship during Deployment

TEXT FIELD

DI

MEDPROS/DMSS

3

DD2795_199905

9

DOB

Yes

CHAR(8)

N

FK

Date of Birth

YYYYMMDD FORMAT

MEDPROS/DMSS

3

DD2795_199905

10

SEX

Yes

CHAR(1)

N

FK

Sex

M = MALE, F = FEMALE

MEDPROS/DMSS

3

DD2795_199905

11

SERVICE

Yes

CHAR(1)

N

FK

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, Z = OTHER/UNKNOWN

MEDPROS/DMSS

3

DD2795_199905

12

FORM_COMPONENT

Yes

CHAR(1)

N

FK

Component

A = ACTIVE DUTY, N = NATIONAL GUARD, R = RESERVES, X = CIVILIAN GOV EMPLOYEE

MEDPROS/DMSS

3

DD2795_199905

13

GRADE

Yes

CHAR(3)

N

FK

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O1, O02 = 02, O03 = O3, O04 = O4, O05 = O5, O06 = O6, O07 = O7, O08 = O8, O09 = O9, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER

DI

MEDPROS/DMSS

3

DD2795_199905

14

OPERATION_LOCATION

Yes

CHAR(2)

N

FK

Location of Operation

01 = EUROPE, 02 = SW ASIA, 03 = SE ASIA, 04 = ASIA (OTHER), 05 = SOUTH AMERICA, 06 = AUSTRALIA, 07 = AFRICA, 08 = CENTRAL AMERICA, 09 = UNKNOWN

MEDPROS/DMSS

3

DD2795_199905

15

DEPLOY_LOCATION

Yes

CHAR(15)

Y

Deployment Location

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

16

COUNTRY

Yes

CHAR(15)

Y

Country

TEXT FIELD

MEDPROS/DMSS

3

DD2795_199905

17

OPERATION_NAME

Yes

CHAR(15)

Y

Name of Operation

TEXT FIELD

MEDPROS/DMSS

3

DD2795_199905

18

ADMIN_MED_THREAT

Yes

CHAR(1)

N

FK

Medical threat briefing completed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

19

ADMIN_INFO_SHEET

Yes

CHAR(1)

N

FK

Medical information sheet distributed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

20

ADMIN_HIV_DRAW

Yes

CHAR(1)

N

FK

Serum for HIV drawn within 12 months

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

21

ADMIN_IMM_CURRENT

Yes

CHAR(1)

N

FK

Immunizations current

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

22

ADMIN_PPD_SCREEN

Yes

CHAR(1)

N

FK

PPD screening within 24 months

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

23

HEALTH_ASSESSMENT

Yes

CHAR(1)

Y

FK

Would you say your health in general is:

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR

MEDPROS/DMSS

3

DD2795_199905

24

MED_PROBLEMS

Yes

CHAR(1)

Y

FK

Do you have any medical or dental problems?

Y = YES, N = NO

MEDPROS/DMSS

3

DD2795_199905

25

LIGHT_DUTY

Yes

CHAR(1)

Y

FK

Are your currently on a profile, or light duty, or are you undergoing a medical board?

Y = YES, N = NO

MEDPROS/DMSS

3

DD2795_199905

26

PREGNANT

Yes

CHAR(1)

Y

FK

Are you pregnant?

Y = YES, N = NO, Z = DON'T KNOW, <NULL> for males

MEDPROS/DMSS

3

DD2795_199905

27

MEDS_SUPPLY

Yes

CHAR(1)

Y

FK

Do you have a 90-day supply of your prescription medication or birth control pills?

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

28

PERSONAL_MED_EQUIP

Yes

CHAR(1)

Y

FK

Do you have two pairs of prescription glasses and any other personal medical equipment?

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

3

DD2795_199905

29

MENTAL_HEALTH

Yes

CHAR(1)

Y

FK

During the past year, have you sought counseling for your mental health?

Y = YES, N = NO

MEDPROS/DMSS

3

DD2795_199905

30

HEALTH_CONCERNS

Yes

CHAR(1)

Y

FK

Do you currently have any questions or concerns about your health?

Y = YES, N = NO

MEDPROS/DMSS

3

DD2795_199905

31

HEALTH_CONCERNS_TEXT

Yes

CHAR(100)

Y

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

32

CERT_MEMBER

Yes

CHAR(1)

N

FK

Member's Signature

MEMBER SIGNATURE, "Y", "N"

MEDPROS/DMSS

3

DD2795_199905

33

REF_NONE

Yes

CHAR(1)

Y

FK

Referral indicated - none

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

34

REF_CARDIAC

Yes

CHAR(1)

Y

FK

Referral indicated - cardiac

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

35

REF_COMBAT

Yes

CHAR(1)

Y

FK

Referral indicated - combat / operational stress reaction

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

36

REF_DENTAL

Yes

CHAR(1)

Y

FK

Referral indicated - dental

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

37

REF_DERM

Yes

CHAR(1)

Y

FK

Referral indicated - dermatologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

38

REF_ENT

Yes

CHAR(1)

Y

FK

Referral indicated - ENT

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

39

REF_EYE

Yes

CHAR(1)

Y

FK

Referral indicated - Eye

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

40

REF_FAMILY

Yes

CHAR(1)

Y

FK

Referral indicated - Family Problems

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

41

REF_FATIGUE

Yes

CHAR(1)

Y

FK

Referral indicated - Fatigue, Malaise, Multisystem complaint

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

42

REF_GI

Yes

CHAR(1)

Y

FK

Referral indicated - GI

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

43

REF_GU

Yes

CHAR(1)

Y

FK

Referral indicated - GU

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

44

REF_GYN

Yes

CHAR(1)

Y

FK

Referral indicated - GYN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

45

REF_MENTAL

Yes

CHAR(1)

Y

FK

Referral indicated - Mental Health

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

46

REF_NEURO

Yes

CHAR(1)

Y

FK

Referral indicated - Neurologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

47

REF_ORTHO

Yes

CHAR(1)

Y

FK

Referral indicated - Orthopedic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

48

REF_PREGNANCY

Yes

CHAR(1)

Y

FK

Referral indicated - Pregnancy

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

49

REF_PULMONARY

Yes

CHAR(1)

Y

FK

Referral indicated - Pulmonary

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

50

REF_OTHER

Yes

CHAR(1)

Y

FK

Referral indicated - Other

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

3

DD2795_199905

51

REF_OTHER_TEXT

Yes

CHAR(15)

Y

Referral indicated - Other Text

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

52

MED_DISP

Yes

CHAR(1)

N

FK

Final Medical Disposition

Y = DEPLOYABLE, N = NOT DEPLOYABLE

MEDPROS/DMSS

3

DD2795_199905

53

MED_DISP_TEXT

Yes

CHAR(100)

Y

Medical Disposition

TEXT FIELD

yes

MEDPROS/DMSS

3

DD2795_199905

54

CERT_PROVIDER

Yes

CHAR(1)

N

FK

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

3

DD2795_199905

55

D_CERT_PROVIDER

Yes

CHAR(8)

N

FK

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

3

DD2795_199905

56

ENTRY_ZIP

Yes

CHAR(5)

N

FK

Zip code of location where form is filled out

MEDPROS/DMSS

4

DD2796_199905

1

FORM_TYPE

Yes

CHAR(4)

Type of Form

POST

MEDPROS/DMSS

4

DD2796_199905

2

FORM_VERSION

Yes

CHAR(15)

DOD Form Number

james.pruett: This version of the form was never used by MEDPROS, and should have been removed from tables. DD2796_199905

MEDPROS/DMSS

4

DD2796_199905

3

SSN

Yes

CHAR(9)

Social Security Number

999999999

DI

MEDPROS/DMSS

4

DD2796_199905

4

LNAME

Yes

CHAR(25)

Last Name

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

5

FNAME

Yes

CHAR(15)

First Name

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

6

MI

Yes

CHAR(1)

Middle Initial

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

7

D_EVENT

Yes

CHAR(8)

Today's Date (date on form)

YYYYMMDD FORMAT

MEDPROS/DMSS

4

DD2796_199905

8

DEPLOYING_UNIT

Yes

CHAR(20)

Name of Unit or Ship during Deployment

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

9

DOB

Yes

CHAR(8)

Date of Birth

YYYYMMDD FORMAT

MEDPROS/DMSS

4

DD2796_199905

10

D_ARRIVAL

Yes

CHAR(8)

Date of arrival in theater

YYYYMMDD FORMAT

MEDPROS/DMSS

4

DD2796_199905

11

D_DEPART

Yes

CHAR(8)

Date of departure from theater

YYYYMMDD FORMAT

MEDPROS/DMSS

4

DD2796_199905

12

SEX

Yes

CHAR(1)

Sex

M = MALE, F = FEMALE

MEDPROS/DMSS

4

DD2796_199905

13

SERVICE

Yes

CHAR(1)

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, Z = OTHER/UNKNOWN

MEDPROS/DMSS

4

DD2796_199905

14

FORM_COMPONENT

Yes

CHAR(1)

Component

A = ACTIVE DUTY, N = NATIONAL GUARD, R = RESERVES, X = CIVILIAN GOV EMPLOYEE

MEDPROS/DMSS

4

DD2796_199905

15

GRADE

Yes

CHAR(3)

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O1, O02 = 02, O03 = O3, O04 = O4, O05 = O5, O06 = O6, O07 = O7, O08 = O8, O09 = O9, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER

DI

MEDPROS/DMSS

4

DD2796_199905

16

OPERATION_LOCATION

Yes

CHAR(2)

Location of Operation

01 = EUROPE, 02 = SW ASIA, 03 = SE ASIA, 04 = ASIA (OTHER), 05 = SOUTH AMERICA, 06 = AUSTRALIA, 07 = AFRICA, 08 = CENTRAL AMERICA, 09 = UNKNOWN

MEDPROS/DMSS

4

DD2796_199905

17

DEPLOY_LOCATION

Yes

CHAR(15)

Deployment Location

TEXT FIELD

Yes

MEDPROS/DMSS

4

DD2796_199905

18

COUNTRY

Yes

CHAR(15)

Country

TEXT FIELD

MEDPROS/DMSS

4

DD2796_199905

19

OPERATION_NAME

Yes

CHAR(15)

Name of Operation

TEXT FIELD

MEDPROS/DMSS

4

DD2796_199905

20

ADMIN_MED_THREAT

Yes

CHAR(1)

Medical threat debriefing completed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

4

DD2796_199905

21

ADMIN_INFO_SHEET

Yes

CHAR(1)

Medical information sheet distributed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

4

DD2796_199905

22

ADMIN_HIV_DRAW

Yes

CHAR(1)

Post-Deployment serum specimen collected

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

4

DD2796_199905

23

HEALTH_ASSESSMENT

Yes

CHAR(1)

Would you say your health in general is:

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR

MEDPROS/DMSS

4

DD2796_199905

24

MED_PROBLEMS

Yes

CHAR(1)

Do you have any medical or dental problems?

Y = YES, N = NO

MEDPROS/DMSS

4

DD2796_199905

25

LIGHT_DUTY

Yes

CHAR(1)

Are your currently on a profile, or light duty, or are you undergoing a medical board?

Y = YES, N = NO

MEDPROS/DMSS

4

DD2796_199905

26

FILLER

Yes

CHAR(3)

Filler

Blanks

MEDPROS/DMSS

4

DD2796_199905

27

MENTAL_HEALTH

Yes

CHAR(1)

During the past year, have you sought counseling for your mental health?

Y = YES, N = NO

MEDPROS/DMSS

4

DD2796_199905

28

HEALTH_CONCERNS

Yes

CHAR(1)

Do you currently have any questions or concerns about your health?

Y = YES, N = NO

MEDPROS/DMSS

4

DD2796_199905

29

HEALTH_CONCERNS_TEXT

Yes

CHAR(100)

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

30

EXPOSURE_CONCERNS

Yes

CHAR(1)

Do you concerns about possible exposures or events during this deployment that you feel may affect your health?

Y = YES, N = NO

MEDPROS/DMSS

4

DD2796_199905

31

EXP_CONCERNS_TEXT

Yes

CHAR(100)

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

32

CERT_MEMBER

Yes

CHAR(1)

Member's Signature

MEMBER SIGNATURE, "Y", "N"

MEDPROS/DMSS

4

DD2796_199905

33

REF_NONE

Yes

CHAR(1)

Referral indicated - none

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

34

REF_CARDIAC

Yes

CHAR(1)

Referral indicated - cardiac

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

35

REF_COMBAT

Yes

CHAR(1)

Referral indicated - combat / operational stress reaction

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

36

REF_DENTAL

Yes

CHAR(1)

Referral indicated - dental

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

37

REF_DERM

Yes

CHAR(1)

Referral indicated - dermatologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

38

REF_ENT

Yes

CHAR(1)

Referral indicated - ENT

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

39

REF_EYE

Yes

CHAR(1)

Referral indicated - Eye

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

40

REF_FAMILY

Yes

CHAR(1)

Referral indicated - Family Problems

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

41

REF_FATIGUE

Yes

CHAR(1)

Referral indicated - Fatigue, Malaise, Multisystem complaint

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

42

REF_GI

Yes

CHAR(1)

Referral indicated - GI

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

43

REF_GU

Yes

CHAR(1)

Referral indicated - GU

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

44

REF_GYN

Yes

CHAR(1)

Referral indicated - GYN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

45

REF_MENTAL

Yes

CHAR(1)

Referral indicated - Mental Health

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

46

REF_NEURO

Yes

CHAR(1)

Referral indicated - Neurologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

47

REF_ORTHO

Yes

CHAR(1)

Referral indicated - Orthopedic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

48

REF_PREGNANCY

Yes

CHAR(1)

Referral indicated - Pregnancy

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

49

REF_PULMONARY

Yes

CHAR(1)

Referral indicated - Pulmonary

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

50

REF_OTHER

Yes

CHAR(1)

Referral indicated - Other

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

51

REF_OTHER_TEXT

Yes

CHAR(15)

Referral indicated - Other Text

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

52

PROVIDER_CONCERNS_ENVIRO

Yes

CHAR(1)

Exposure concerns environmental

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

53

PROVIDER_CONCERNS_OCC

Yes

CHAR(1)

Exposure concerns occupational

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

54

PROVIDER_CONCERNS_COMBAT

Yes

CHAR(1)

Exposure concerns combat or mission related

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

55

PROVIDER_CONCERNS_NONE

Yes

CHAR(1)

Exposure concerns none

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

4

DD2796_199905

56

CERT_PROVIDER

Yes

CHAR(1)

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

4

DD2796_199905

57

D_CERT_PROVIDER

Yes

CHAR(8)

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

4

DD2796_199905

58

PROVIDER_COMMENTS

Yes

CHAR(100)

Comments

TEXT FIELD

yes

MEDPROS/DMSS

4

DD2796_199905

59

ENTRY_ZIP

Yes

CHAR(5)

Zip code of location where form is filled out

MEDPROS/DMSS

5

DD2796_200304

1

FORM_TYPE

Yes

CHAR(4)

N

PK

Type of Form

POST

MEDPROS/DMSS

5

DD2796_200304

2

FORM_VERSION

Yes

CHAR(15)

N

PK

DOD Form Number

DD2796_200304

MEDPROS/DMSS

5

DD2796_200304

3

SSN

Yes

CHAR(9)

N

PK

Social Security Number

999999999

DI

MEDPROS/DMSS

5

DD2796_200304

4

LNAME

Yes

CHAR(25)

N

Last Name

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

5

FNAME

Yes

CHAR(15)

N

First Name

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

6

MI

Yes

CHAR(1)

Y

Middle Initial

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

7

D_EVENT

Yes

CHAR(8)

N

FK

Today's Date (date on form)

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

8

DEPLOYING_UNIT

Yes

CHAR(20)

Y

Name of Unit or Ship during Deployment

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

9

DOB

Yes

CHAR(8)

N

FK

Date of Birth

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

10

D_ARRIVAL

Yes

CHAR(8)

N

FK

Date of arrival in theater

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

11

D_DEPART

Yes

CHAR(8)

N

FK

Date of departure from theater

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

12

SEX

Yes

CHAR(1)

N

FK

Sex

M = MALE, F = FEMALE

MEDPROS/DMSS

5

DD2796_200304

13

SERVICE

Yes

CHAR(1)

N

FK

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, Z = OTHER/UNKNOWN

MEDPROS/DMSS

5

DD2796_200304

14

FORM_COMPONENT

Yes

CHAR(1)

N

FK

Component

A = ACTIVE DUTY, N = NATIONAL GUARD, R = RESERVES, X = CIVILIAN GOV EMPLOYEE

MEDPROS/DMSS

5

DD2796_200304

15

GRADE

Yes

CHAR(3)

N

FK

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O1, O02 = 02, O03 = O3, O04 = O4, O05 = O5, O06 = O6, O07 = O7, O08 = O8, O09 = O9, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER

DI

MEDPROS/DMSS

5

DD2796_200304

16

OPERATION_LOCATION

Yes

CHAR(2)

N

FK

Location of Operation

01 = EUROPE, 02 = SW ASIA, 03 = SE ASIA, 04 = ASIA (OTHER), 05 = SOUTH AMERICA, 06 = AUSTRALIA, 07 = AFRICA, 08 = CENTRAL AMERICA, 09 = UNKNOWN, 10 = NORTH AMERICA, 11 = OTHER

MEDPROS/DMSS

5

DD2796_200304

17

OPERATION_LOCATION_TEXT

Yes

CHAR(15)

Y

Location of Operation Other Text

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

18

KUWAIT

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

19

KUWAIT_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

20

KUWAIT_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

21

QATAR

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

22

QATAR_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

23

QATAR_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

24

AFGHAN

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

25

AFGHAN_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

26

AFGHAN_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

27

BOSNIA

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

28

BOSNIA_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

29

BOSNIA_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

30

SHIP

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

31

SHIP_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

32

SHIP_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

33

IRAQ

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

34

IRAQ_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

35

IRAQ_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

36

TURKEY

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

37

TURKEY_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

38

TURKEY_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

39

UZBEK

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

40

UZBEK_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

41

UZBEK_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

42

KOSOVO

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

43

KOSOVO_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

44

KOSOVO_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

45

CONUS

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

46

CONUS_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

47

CONUS_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

48

OTHER

Yes

CHAR(1)

Y

FK

Mainly deployed?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

49

OTHER_WHERE

Yes

CHAR(15)

Y

Where?

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

50

OTHER_D_ARRIVAL

Yes

CHAR(8)

Y

FK

Date Arrived

YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

51

OPERATION_NAME

Yes

CHAR(15)

Y

Name of Operation

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

52

ADMIN_MED_THREAT

Yes

CHAR(1)

N

FK

Medical threat debriefing completed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

5

DD2796_200304

53

ADMIN_INFO_SHEET

Yes

CHAR(1)

N

FK

Medical information sheet distributed

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

5

DD2796_200304

54

ADMIN_HIV_DRAW

Yes

CHAR(1)

N

FK

Post-Deployment serum specimen collected

Y = YES, N = NO, X = N/A

MEDPROS/DMSS

5

DD2796_200304

55

OCC_SPECIALTY

Yes

CHAR(6)

N

FK

Occupational specialty

MOS, NEC, AFSC

MEDPROS/DMSS

5

DD2796_200304

56

COMBAT_SPECIALTY

Yes

CHAR(15)

N

Combat specialty

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

57

HEALTH_CHANGE

Yes

CHAR(1)

Y

FK

Did your health change during this deployment?

N = HEALTH STAYED SAME OR GOT BETTER, Y = HEALTH GOT WORSE

MEDPROS/DMSS

5

DD2796_200304

58

TIMES_SEEN

Yes

NUMBER(2)

Y

FK

How many time were you seen in sick call during this deployment?

2-DIGIT NUMBER

MEDPROS/DMSS

5

DD2796_200304

59

HOSPITALIZED

Yes

CHAR(1)

Y

FK

Did you have to spend one or more nights in a hospital as a patient during this deployment?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

60

HOSPITALIZED_TEXT

Yes

CHAR(75)

Y

Yes, reason/dates

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

61

VAC_SMALLPOX

Yes

CHAR(1)

Y

FK

Received small pox vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

62

VAC_ANTHRAX

Yes

CHAR(1)

Y

FK

Received anthrax vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

63

VAC_BOTULISM

Yes

CHAR(1)

Y

FK

Received botulism vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

64

VAC_TYPHOID

Yes

CHAR(1)

Y

FK

Received typhoid vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

65

VAC_MENING

Yes

CHAR(1)

Y

FK

Received meningococcal vaccination just before or duing deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

66

VAC_OTHER

Yes

CHAR(1)

Y

FK

Received other vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

67

VAC_OTHER_TEXT

Yes

CHAR(15)

Y

Explanation of other vaccination

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

68

VAC_DK

Yes

CHAR(1)

Y

FK

Don't know if received any vaccinations before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

69

VAC_NONE

Yes

CHAR(1)

Y

FK

Received no vaccinations before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

70

MEDS_PB

Yes

CHAR(1)

Y

FK

Took PB during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

71

MEDS_MARK1

Yes

CHAR(1)

Y

FK

Took Mark-1 during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

72

MEDS_MALARIA

Yes

CHAR(1)

Y

FK

Took anti-malaria pills during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

73

MEDS_AWAKE

Yes

CHAR(1)

Y

FK

Took pills to stay awake during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

74

MEDS_OTHER

Yes

CHAR(1)

Y

FK

Took other medications during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

75

MEDS_OTHER_TEXT

Yes

CHAR(15)

Y

Explanation of other medications

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

76

MEDS_DK

Yes

CHAR(1)

Y

FK

Did you take this medication during this deployment?

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

77

COUGH

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

78

RUNNY_NOSE

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

79

FEVER

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

80

WEAKNESS

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

81

HEADACHE

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

82

JOINTS

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

83

BACK_PAIN

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

84

MUSCLE

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

85

NUMBNESS

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

86

RASH

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

87

TEARING

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

88

VISION

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

89

CHEST_PAIN

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

90

DIZZY

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

91

BREATHING

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

92

TIRED

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

93

MEMORY

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

94

DIARRHEA

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

95

INDIGESTION

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

96

VOMITING

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

97

RINGING

Yes

CHAR(1)

Y

FK

Did not have this symptom

1 = NO, 2 = YES DURING, 3 = YES NOW, 4 = YES DURING AND YES NOW

MEDPROS/DMSS

5

DD2796_200304

98

KILLED_NO

Yes

CHAR(1)

Y

FK

Did not see anyone wounded, killed or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

99

KILLED_COALITION

Yes

CHAR(1)

Y

FK

Saw coalition member wounded, killed or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

100

KILLED_ENEMY

Yes

CHAR(1)

Y

FK

Saw enemy wounded, killed, or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

101

KILLED_CIVILIAN

Yes

CHAR(1)

Y

FK

Saw civilian wounded, killed, or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

102

WEAPON

Yes

CHAR(1)

Y

FK

Did not discharge weapon

N = NO, Y = YES

MEDPROS/DMSS

5

DD2796_200304

103

WEAPON_LAND

Yes

CHAR(1)

Y

FK

Discharged weapon from land

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

104

WEAPON_SEA

Yes

CHAR(1)

Y

FK

Discharged weapon from sea

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

105

WEAPON_AIR

Yes

CHAR(1)

Y

FK

Dischared weapon from air

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

106

DANGER_KILLED

Yes

CHAR(1)

Y

FK

During this deployment, did you ever feel that you were in great danger of being killed?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

107

RECEIVING_HELP

Yes

CHAR(1)

Y

FK

Are you currently interested in receiving help for a stress, emotional, alcohol, or family problem?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

108

LITTLE_INTEREST

Yes

CHAR(1)

Y

FK

Over last 2 weeks had little interest or pleasure in doing things

N = NONE, S = SOME, A = A LOT

MEDPROS/DMSS

5

DD2796_200304

109

FEELING_DOWN

Yes

CHAR(1)

Y

FK

Over last 2 weeks feeling down, depressed, or hopeless

N = NONE, S = SOME, A = A LOT

MEDPROS/DMSS

5

DD2796_200304

110

HURT_SELF

Yes

CHAR(1)

Y

FK

Over last 2 weeks thoughts that you would be better off dead or hurting yourself in some way.

N = NONE, S = SOME, A = A LOT

MEDPROS/DMSS

5

DD2796_200304

111

NIGHTMARES

Yes

CHAR(1)

Y

FK

Past month had nightmares or thoughts when Did not want to

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

112

AVOID_SITUATIONS

Yes

CHAR(1)

Y

FK

Past month, tried hard NOT to think about it or avoided situations

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

113

ON_GUARD

Yes

CHAR(1)

Y

FK

Past month, constantly on guard, watchful or easily startled

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

114

DETACHED

Yes

CHAR(1)

Y

FK

Past month, felt numb, detached from others, activities, or surroundings

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

115

CONFLICTS

Yes

CHAR(1)

Y

FK

Thoughts or concerns about serious conflicts with spouse, family, or friends

Y = YES, N = NO, Z = UNSURE

MEDPROS/DMSS

5

DD2796_200304

116

LOSE_CONTROL

Yes

CHAR(1)

Y

FK

Thoughts or concerns about hurting or losing control with someone

Y = YES, N = NO, Z = UNSURE

MEDPROS/DMSS

5

DD2796_200304

117

EXP_DEET

Yes

CHAR(1)

Y

FK

Exposed to DEET

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

118

EXP_PEST_UNIFORM

Yes

CHAR(1)

Y

FK

Exposed to pesticide treated uniforms

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

119

EXP_PEST_ENVIRO

Yes

CHAR(1)

Y

FK

Exposed to environmental pesticides

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

120

EXP_FLEA

Yes

CHAR(1)

Y

FK

Exposed to flea or tick collars

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

121

EXP_PEST_STRIP

Yes

CHAR(1)

Y

FK

Exposed to pesticide strips

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

122

EXP_SMOKE_OIL

Yes

CHAR(1)

Y

FK

Exposed to smoke from oil fires

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

123

EXP_SMOKE_TRASH

Yes

CHAR(1)

Y

FK

Exposed to smoke from burning trash or feces

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

124

EXP_FUMES_EXHAUST

Yes

CHAR(1)

Y

FK

Exposed to vehicle or truch exhaust fumes

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

125

EXP_SMOKE_HEATER

Yes

CHAR(1)

Y

FK

Exposed to tent heater smoke

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

126

EXP_FUELS

Yes

CHAR(1)

Y

FK

Exposed to JP8 or other fuels

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

127

EXP_FOG_OILS

Yes

CHAR(1)

Y

FK

Exposed to fog oils

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

128

EXP_SOLVENTS

Yes

CHAR(1)

Y

FK

Exposed to solvents

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

129

EXP_PAINTS

Yes

CHAR(1)

Y

FK

Exposed to paints

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

130

EXP_RADIATION

Yes

CHAR(1)

Y

FK

Exposed to ionizing radiation

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

131

EXP_MICROWAVE

Yes

CHAR(1)

Y

FK

Exposed to radar/microwave

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

132

EXP_LASER

Yes

CHAR(1)

Y

FK

Exposed to lasers

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

133

EXP_NOISE

Yes

CHAR(1)

Y

FK

Exposed to loud noises

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

134

EXP_VIBRATION

Yes

CHAR(1)

Y

FK

Exposed to excessive vibration

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

135

EXP_POLLUTION

Yes

CHAR(1)

Y

FK

Exposed to industrial pollution

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

136

EXP_SAND

Yes

CHAR(1)

Y

FK

Exposed to sand/dust

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

137

EXP_URANIUM

Yes

CHAR(1)

Y

FK

Exposted to depleted uranium

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

138

EXP_URANIUM_TEXT

Yes

CHAR(15)

Y

Explanation of exposure to depleted uranium

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

139

EXP_OTHER

Yes

CHAR(1)

Y

FK

Other exposures

N = NO, S = SOMETIMES, O = OFTEN

MEDPROS/DMSS

5

DD2796_200304

140

EXP_OTHER_TEXT

Yes

CHAR(15)

Y

Explanation of other exposures

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

141

DAYS_MOPP

Yes

NUMBER(2)

Y

FK

How many days did your wear your MOPP over garments?

2-DIGIT NUMBER

MEDPROS/DMSS

5

DD2796_200304

142

TIMES_MASK

Yes

NUMBER(2)

Y

FK

How many times did you put on your gas masks because of alerts, NOT exercises?

2-DIGIT NUMBER

MEDPROS/DMSS

5

DD2796_200304

143

DESTROYED_VEHICLES

Yes

CHAR(1)

Y

FK

Were you in or did you enter or closely inspect any destroyed military vehicles?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

144

CBR_AGENTS

Yes

CHAR(1)

Y

FK

Do you think you were exposed to any chemical, biological, or radiological warfare agents?

Y = YES, N = NO, Z = DON’T KNOW

MEDPROS/DMSS

5

DD2796_200304

145

CBR_AGENTS_TEXT

Yes

CHAR(75)

Y

If exposed, explain with date and location

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

146

HEALTH_ASSESSMENT

Yes

CHAR(1)

Y

FK

Would you say your health in general is:

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR

MEDPROS/DMSS

5

DD2796_200304

147

MED_PROBLEMS

Yes

CHAR(1)

Y

FK

Do you have any medical or dental problems?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

148

LIGHT_DUTY

Yes

CHAR(1)

Y

FK

Are your currently on a profile, or light duty, or are you undergoing a medical board?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

149

FILLER

Yes

CHAR(3)

Y

FK

Filler

Blanks

MEDPROS/DMSS

5

DD2796_200304

150

MENTAL_HEALTH

Yes

CHAR(1)

Y

FK

During the past year, have you sought counseling for your mental health?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

151

HEALTH_CONCERNS

Yes

CHAR(1)

Y

FK

Do you currently have any questions or concerns about your health?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

152

HEALTH_CONCERNS_TEXT

Yes

CHAR(100)

Y

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

153

EXPOSURE_CONCERNS

Yes

CHAR(1)

Y

FK

Do you concerns about possible exposures or events during this deployment that you feel may affect your health?

Y = YES, N = NO

MEDPROS/DMSS

5

DD2796_200304

154

EXP_CONCERNS_TEXT

Yes

CHAR(100)

Y

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

155

FILLER2

Yes

CHAR(1)

Y

FK

Filler

Blanks

MEDPROS/DMSS

5

DD2796_200304

156

REF_NONE

Yes

CHAR(1)

N

FK

Referral indicated - none

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

157

REF_CARDIAC

Yes

CHAR(1)

N

FK

Referral indicated - cardiac

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

158

REF_COMBAT

Yes

CHAR(1)

N

FK

Referral indicated - combat / operational stress reaction

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

159

REF_DENTAL

Yes

CHAR(1)

N

FK

Referral indicated - dental

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

160

REF_DERM

Yes

CHAR(1)

N

FK

Referral indicated - dermatologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

161

REF_ENT

Yes

CHAR(1)

N

FK

Referral indicated - ENT

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

162

REF_EYE

Yes

CHAR(1)

N

FK

Referral indicated - Eye

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

163

REF_FAMILY

Yes

CHAR(1)

N

FK

Referral indicated - Family Problems

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

164

REF_FATIGUE

Yes

CHAR(1)

N

FK

Referral indicated - Fatigue, Malaise, Multisystem complaint

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

165

REF_AUDIOLOGY

Yes

CHAR(1)

N

FK

Referral indicated - Audiology

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

166

REF_GI

Yes

CHAR(1)

N

FK

Referral indicated - GI

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

167

REF_GU

Yes

CHAR(1)

N

FK

Referral indicated - GU

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

168

REF_GYN

Yes

CHAR(1)

N

FK

Referral indicated - GYN

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

169

REF_MENTAL

Yes

CHAR(1)

N

FK

Referral indicated - Mental Health

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

170

REF_NEURO

Yes

CHAR(1)

N

FK

Referral indicated - Neurologic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

171

REF_ORTHO

Yes

CHAR(1)

N

FK

Referral indicated - Orthopedic

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

172

REF_PREGNANCY

Yes

CHAR(1)

N

FK

Referral indicated - Pregnancy

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

173

REF_PULMONARY

Yes

CHAR(1)

N

FK

Referral indicated - Pulmonary

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

174

REF_OTHER

Yes

CHAR(1)

N

FK

Referral indicated - Other

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

175

REF_OTHER_TEXT

Yes

CHAR(15)

Y

Referral indicated - Other Text

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

176

PROVIDER_CONCERNS_ENVIRO

Yes

CHAR(1)

Y

FK

Exposure concerns environmental

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

177

PROVIDER_CONCERNS_OCC

Yes

CHAR(1)

Y

FK

Exposure concerns occupational

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

178

PROVIDER_CONCERNS_COMBAT

Yes

CHAR(1)

Y

FK

Exposure concerns combat or mission related

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

179

PROVIDER_CONCERNS_NONE

Yes

CHAR(1)

Y

FK

Exposure concerns none

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

5

DD2796_200304

180

CERT_PROVIDER

Yes

CHAR(1)

N

FK

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

5

DD2796_200304

181

D_CERT_PROVIDER

Yes

CHAR(8)

N

FK

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

5

DD2796_200304

182

PROVIDER_COMMENTS

Yes

CHAR(100)

Y

Comments

TEXT FIELD

yes

MEDPROS/DMSS

5

DD2796_200304

183

ENTRY_ZIP

Yes

CHAR(5)

N

FK

Zip code of location where form is filled out

MEDPROS/DMSS

6

DD2796_200801

1

FORM_TYPE

Yes

Char(4)

N

PK

Type of Form

POST

MEDPROS/DMSS

6

DD2796_200801

2

FORM_VERSION

Yes

Char(15)

N

PK

DOD Form Number

DD2796_200801, pad with two whitespaces to the right

MEDPROS/DMSS

6

DD2796_200801

3

SSN

Yes

Char(9)

N

PK

Social Security Number

NNNNNNNNN

DI

MEDPROS/DMSS

6

DD2796_200801

4

LNAME

Yes

Char(25)

N

Last Name

TEXT FIELD

Yes

MEDPROS/DMSS

6

DD2796_200801

5

FNAME

Yes

Char(15)

N

First Name

TEXT FIELD

Yes

MEDPROS/DMSS

6

DD2796_200801

6

MI

Yes

Char(1)

Y

Middle Initial

TEXT FIELD

Yes

MEDPROS/DMSS

6

DD2796_200801

7

D_EVENT

Yes

Char(8)

N

FK

Today's Date (date on form)

YYYYMMDD, <=SYSDATE

MEDPROS/DMSS

6

DD2796_200801

8

DOB

Yes

Char(8)

N

FK

Date of Birth

YYYYMMDD, <=SYSDATE

MEDPROS/DMSS

6

DD2796_200801

9

SEX

Yes

Char(1)

Y

FK

Gender

M=Male, F=female, blank=not marked

MEDPROS/DMSS

6

DD2796_200801

10

DEPLOYING_UNIT

Yes

Char(20)

Y

Name of Unit or Ship during Deployment

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

11

SERVICE

Yes

Char(1)

Y

FK

Service

A = ARMY, F = AIR FORCE, C = COAST GUARD, M = MARINES, N = NAVY, X=CIVILIAN/GS, Z = OTHER, Blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

12

FORM_COMPONENT

Yes

Char(1)

Y

FK

Component

A = ACTIVE DUTY, N = NATIONAL GUARD, R = RESERVES, X = CIVILIAN GOV EMPLOYEE, Z=other, Blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

13

GRADE

Yes

Char(3)

Y

FK

Pay Grade

E01 = E1, E02 = E2, E03 = E3, E04 = E4, E05 = E5, E06 = E6, E07 = E7, E08 = E8, E09 = E9, O01 = O1, O02 = 02, O03 = O3, O04 = O4, O05 = O5, O06 = O6, O07 = O7, O08 = O8, O09 = O9, O10 = O10, W01 = W1, W02 = W2, W03 = W3, W04 = W4, W05 = W5, ZZZ = OTHER, Blank=Not marked

DI

MEDPROS/DMSS

6

DD2796_200801

14

D_ARRIVAL

Yes

Char(8)

N

FK

Date of arrival in theater

YYYYMMDD <= SYSDATE and D_DEPART

MEDPROS/DMSS

6

DD2796_200801

15

D_DEPART

Yes

Char(8)

N

FK

Date of departure from theater

YYYYMMDD, >= D_ARRIVAL

MEDPROS/DMSS

6

DD2796_200801

16

OPERATION_NAME

Yes

Char(15)

Y

Name of Operation

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

17

COUNTRY1

Yes

Char(2)

N

FK

Country 1

Two character FIPS 10 country code

MEDPROS/DMSS

6

DD2796_200801

18

COUNTRY1_MONTHS

Yes

Char(2)

N

FK

Months in country 1

NN

MEDPROS/DMSS

6

DD2796_200801

19

COUNTRY2

Yes

Char(2)

Y

FK

Country 2

Two character FIPS 10 country code

MEDPROS/DMSS

6

DD2796_200801

20

COUNTRY2_MONTHS

Yes

Char(2)

Y

FK

Months in country 2

NN

MEDPROS/DMSS

6

DD2796_200801

21

COUNTRY3

Yes

Char(2)

Y

FK

Country 3

Two character FIPS 10 country code

MEDPROS/DMSS

6

DD2796_200801

22

COUNTRY3_MONTHS

Yes

Char(2)

Y

FK

Months in country 3

NN

MEDPROS/DMSS

6

DD2796_200801

23

COUNTRY4

Yes

Char(2)

Y

FK

Country 4

Two character FIPS 10 country code

MEDPROS/DMSS

6

DD2796_200801

24

COUNTRY4_MONTHS

Yes

Char(2)

Y

FK

Months in country 4

NN

MEDPROS/DMSS

6

DD2796_200801

25

COUNTRY5

Yes

Char(2)

Y

FK

Country 5

Two character FIPS 10 country code

MEDPROS/DMSS

6

DD2796_200801

26

COUNTRY5_MONTHS

Yes

Char(2)

Y

FK

Months in country 5

NN

MEDPROS/DMSS

6

DD2796_200801

27

OCC_SPECIALTY

Yes

Char(6)

Y

Occupational specialty

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

28

COMBAT_SPECIALTY

Yes

Char(15)

Y

Specialty during deployment

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

29

PHONE

Yes

Char(20)

Y

Current Phone

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

30

CELL

Yes

Char(20)

Y

Current Cell Phone

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

31

DSN

Yes

Char(20)

Y

Current DSN

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

32

EMAIL

Yes

Char(30)

Y

Current Email

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

33

ADDR

Yes

Char(60)

Y

Current Address

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

34

CITY

Yes

Char(25)

Y

Current CITY

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

35

STATE

Yes

Char(2)

Y

Current STATE

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

36

ZIP

Yes

Char(10)

Y

Current ZIP Code

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

37

POC_NAME

Yes

Char(30)

Y

POC Name

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

38

POC_PHONE

Yes

Char(20)

Y

POC Phone

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

39

POC_EMAIL

Yes

Char(30)

Y

POC Email

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

40

POC_ADDR

Yes

Char(60)

Y

POC Address

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

41

POC_CITY

Yes

Char(25)

Y

POC CITY

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

42

POC_STATE

Yes

Char(2)

Y

POC STATE

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

43

POC_ZIP

Yes

Char(10)

Y

POC ZIP Code

TEXT FIELD

MEDPROS/DMSS

6

DD2796_200801

44

HEALTH_ASSESSMENT

Yes

Char(1)

Y

FK

How wold you rate your health during the past month:

E = EXCELLENT, V = VERY GOOD, G = GOOD, F = FAIR, P = POOR, Blank=not marked

MEDPROS/DMSS

6

DD2796_200801

45

HEALTH_CHANGE

Yes

Char(1)

Y

FK

Compared to before this deployment, how would you rate your health in general now??

0 = Much better now than before I deployed, 1 = Somewhat better now than before I deployed, 2 = About the same as before I deployed, 3 = Somewhat worse now than before I deployed, 4 = Much worse now than before I deployed, Blank=not marked

MEDPROS/DMSS

6

DD2796_200801

46

DIFF_PHYSICAL

Yes

Char(1)

Y

FK

During the past 4 weeks, how difficult have physical problems made it for you to do your work?

N = not difficult at all, S = somewhat difficult, V = very difficult, E = extremely difficult, Blank=not marked

MEDPROS/DMSS

6

DD2796_200801

47

DIFF_EMOTIONAL

Yes

Char(1)

Y

FK

During the past 4 weeks, how difficult have emotional problems made it for you to do your work?

N = not difficult at all, S = somewhat difficult, V = very difficult, E = extremely difficult, Blank=not marked

MEDPROS/DMSS

6

DD2796_200801

48

TIMES_SEEN

Yes

Char(2)

Y

FK

How many time were you seen in sick call during this deployment?

NN

MEDPROS/DMSS

6

DD2796_200801

49

HOSPITALIZED

Yes

Char(1)

Y

FK

Did you have to spend one or more nights in a hospital as a patient during this deployment?

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

50

HOSPITALIZED_TEXT

Yes

Char(75)

Y

Yes, reason/dates

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

51

INJURED

Yes

Char(1)

Y

FK

Wounded, Injured or Assaulted during deployment

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

52

INJ_PROB

Yes

Char(1)

Y

FK

Current problems related to being Wounded, Injured or Assaulted during deployment

Y = YES, N = NO, Z = Unsure, blank = not marked

MEDPROS/DMSS

6

DD2796_200801

53

FEVER_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - FEVER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

54

FEVER_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - FEVER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

55

FEVER_STILL

Yes

Char(1)

Y

FK

Still bothered - FEVER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

56

COUGH_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - COUGH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

57

COUGH_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - COUGH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

58

COUGH_STILL

Yes

Char(1)

Y

FK

Still bothered - COUGH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

59

BREATHING_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - BREATHING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

60

BREATHING_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - BREATHING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

61

BREATHING_STILL

Yes

Char(1)

Y

FK

Still bothered - BREATHING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

62

HEADACHE_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - HEADACHE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

63

HEADACHE_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - HEADACHE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

64

HEADACHE_STILL

Yes

Char(1)

Y

FK

Still bothered - HEADACHE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

65

WEAKNESS_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - WEAKNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

66

WEAKNESS_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - WEAKNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

67

WEAKNESS_STILL

Yes

Char(1)

Y

FK

Still bothered - WEAKNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

68

MUSCLE_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - MUSCLE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

69

MUSCLE_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - MUSCLE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

70

MUSCLE_STILL

Yes

Char(1)

Y

FK

Still bothered - MUSCLE

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

71

JOINTS_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - JOINTS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

72

JOINTS_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - JOINTS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

73

JOINTS_STILL

Yes

Char(1)

Y

FK

Still bothered - JOINTS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

74

BACK_PAIN_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - BACK_PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

75

BACK_PAIN_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - BACK PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

76

BACK_PAIN_STILL

Yes

Char(1)

Y

FK

Still bothered - BACK PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

77

NUMBNESS_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - NUMBNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

78

NUMBNESS_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - NUMBNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

79

NUMBNESS_STILL

Yes

Char(1)

Y

FK

Still bothered - NUMBNESS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

80

HEARING_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - HEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

81

HEARING_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - HEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

82

HEARING_STILL

Yes

Char(1)

Y

FK

Still bothered - HEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

83

RINGING_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - RINGING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

84

RINGING_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - RINGING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

85

RINGING_STILL

Yes

Char(1)

Y

FK

Still bothered - RINGING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

86

TEARING_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - TEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

87

TEARING_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - TEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

88

TEARING_STILL

Yes

Char(1)

Y

FK

Still bothered - TEARING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

89

VISION_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - VISION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

90

VISION_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - VISION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

91

VISION_STILL

Yes

Char(1)

Y

FK

Still bothered - VISION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

92

CHEST_PAIN_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - CHEST PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

93

CHEST_PAIN_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - CHEST PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

94

CHEST_PAIN_STILL

Yes

Char(1)

Y

FK

Still bothered - CHEST PAIN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

95

DIZZY_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - DIZZY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

96

DIZZY_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - DIZZY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

97

DIZZY_STILL

Yes

Char(1)

Y

FK

Still bothered - DIZZY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

98

DIARRHEA_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - DIARRHEA

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

99

DIARRHEA_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - DIARRHEA

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

100

DIARRHEA_STILL

Yes

Char(1)

Y

FK

Still bothered - DIARRHEA

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

101

VOMITTING_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - VOMITTING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

102

VOMITTING_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - VOMITTING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

103

VOMITTING_STILL

Yes

Char(1)

Y

FK

Still bothered - VOMITTING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

104

INDIGESTION_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - HEARTBURN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

105

INDIGESTION_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - HEARTBURN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

106

INDIGESTION_STILL

Yes

Char(1)

Y

FK

Still bothered - HEARTBURN

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

107

TIRED_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - TIRED

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

108

TIRED_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - TIRED

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

109

TIRED_STILL

Yes

Char(1)

Y

FK

Still bothered - TIRED

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

110

CONCENTRATION_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - CONCENTRATION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

111

CONCENTRATION_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - CONCENTRATION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

112

CONCENTRATION_STILL

Yes

Char(1)

Y

FK

Still bothered - CONCENTRATION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

113

MEMORY_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - MEMORY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

114

MEMORY_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - MEMORY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

115

MEMORY_STILL

Yes

Char(1)

Y

FK

Still bothered - MEMORY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

116

DECISION_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - DECISION MAKING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

117

DECISION_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - DECISION MAKING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

118

DECISION_STILL

Yes

Char(1)

Y

FK

Still bothered - DECISION MAKING

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

119

IRRITABLE_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - IRRITABILITY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

120

IRRITABLE_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - IRRITABILITY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

121

IRRITABLE_STILL

Yes

Char(1)

Y

FK

Still bothered - IRRITABILITY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

122

RASH_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - RASH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

123

RASH_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - RASH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

124

RASH_STILL

Yes

Char(1)

Y

FK

Still bothered - RASH

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

125

OTHER_COND_SICKCALL

Yes

Char(1)

Y

FK

Went to sick call - OTHER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

126

OTHER_COND_QUARTERS

Yes

Char(1)

Y

FK

Given quarters or profile - OTHER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

127

OTHER_COND_STILL

Yes

Char(1)

Y

FK

Still bothered - OTHER

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

128

OTHER_COND_TEXT

Yes

Char(30)

Y

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

129

EXP_BLAST

Yes

Char(1)

Y

FK

Experienced blast

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

130

EXP_CRASH

Yes

Char(1)

Y

FK

Experienced MVA

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

131

EXP_WOUND

Yes

Char(1)

Y

FK

Experienced fragment or bullet wound above shoulder

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

132

EXP_FALL

Yes

Char(1)

Y

FK

Experienced fall

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

133

EXP_OTHER_EVENT

Yes

Char(1)

Y

FK

Experienced other event

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

134

EXP_OTHER_EVENT_TEXT

Yes

Char(30)

Y

Experienced other event text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

135

IMMED_LOC

Yes

Char(1)

Y

FK

Immediately after event - LOC

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

136

IMMED_DAZED

Yes

Char(1)

Y

FK

Immediately after event - DAZED

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

137

IMMED_MEMORY

Yes

Char(1)

Y

FK

Immediately after event - MEMORY LOSS

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

138

IMMED_CONCUSSION

Yes

Char(1)

Y

FK

Immediately after event - CONCUSSION

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

139

IMMED_HEAD_INJ

Yes

Char(1)

Y

FK

Immediately after event - HEAD INJURY

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

140

POST_LAPSES

Yes

Char(1)

Y

FK

Post event memory lapses

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

141

POST_DIZZY

Yes

Char(1)

Y

FK

Post event diziness

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

142

POST_RINGING

Yes

Char(1)

Y

FK

Post event ringing in the ears

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

143

POST_PHOTOSENS

Yes

Char(1)

Y

FK

Post event photosensitivity

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

144

POST_IRRITABLE

Yes

Char(1)

Y

FK

Post event irritability

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

145

POST_HEADACHE

Yes

Char(1)

Y

FK

Post event headaches

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

146

POST_SLEEP

Yes

Char(1)

Y

FK

Post event sleep problems

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

147

WEEK_MEMORY

Yes

Char(1)

Y

FK

Past week memory lapses

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

148

WEEK_DIZZY

Yes

Char(1)

Y

FK

Past week dizziness

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

149

WEEK_RINGING

Yes

Char(1)

Y

FK

Past week ringing in the ears

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

150

WEEK_PHOTOSENS

Yes

Char(1)

Y

FK

Pask week photosensitivity

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

151

WEEK_IRRITABLE

Yes

Char(1)

Y

FK

Past week irritability

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

152

WEEK_HEADACHE

Yes

Char(1)

Y

FK

Past week headaches

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

153

WEEK_SLEEP

Yes

Char(1)

Y

FK

Past week sleep problems

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

154

KILLED_CHECKED

Yes

Char(1)

Y

FK

Did you encounter/see killed or wounded?

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

155

KILLED_COALITION

Yes

Char(1)

N

FK

Saw coalition member wounded, killed or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

156

KILLED_ENEMY

Yes

Char(1)

N

FK

Saw enemy wounded, killed, or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

157

KILLED_CIVILIAN

Yes

Char(1)

N

FK

Saw civilian wounded, killed, or dead during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

158

WEAPON_CHECKED

Yes

Char(1)

Y

FK

Discharged weapon

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

159

WEAPON_LAND

Yes

Char(1)

N

FK

Discharged weapon from land

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

160

WEAPON_SEA

Yes

Char(1)

N

FK

Discharged weapon from sea

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

161

WEAPON_AIR

Yes

Char(1)

N

FK

Dischared weapon from air

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

162

DANGER_KILLED

Yes

Char(1)

Y

FK

During this deployment, did you ever feel that you were in great danger of being killed?

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

163

NIGHTMARES

Yes

Char(1)

Y

FK

Past month had nightmares or thoughts when Did not want to

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

164

AVOID_SITUATIONS

Yes

Char(1)

Y

FK

Past month, tried hard NOT to think about it or avoided situations

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

165

ON_GUARD

Yes

Char(1)

Y

FK

Past month, constantly on guard, watchful or easily startled

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

166

DETACHED

Yes

Char(1)

Y

FK

Past month, felt numb, detached from others, activities, or surroundings

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

167

LITTLE_INTEREST

Yes

Char(1)

Y

FK

Over past month had little interest or pleasure in doing things

0 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

168

FEELING_DOWN

Yes

Char(1)

Y

FK

Over past month feeling down, depressed, or hopeless

1 = Not at all, 1 = Few or several days, 2 = More than half the days, 3 = Nearly every-day, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

169

ETOH

Yes

Char(1)

Y

FK

Use Alcohol more than meant to

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

170

ETOH_DOWN

Yes

Char(1)

Y

FK

Felt or wanted to cut down alcohol consumption

Y = YES, N = NO, blank=Not marked

MEDPROS/DMSS

6

DD2796_200801

171

ETOH_HOW_OFTEN

Yes

Char(1)

Y

FK

How often do you..

0=never,1=monthly or less, 2 = 2-4 times per month,3=2-3 times per week, 4=4or more times per week, blank=not marked

MEDPROS/DMSS

6

DD2796_200801

172

ETOH_HOW_MANY

Yes

Char(1)

Y

FK

how many drink on a typical day

0=1-2,1=3-4,2=5-6,3=7-9,4=10 or more, blank=not marked

MEDPROS/DMSS

6

DD2796_200801

173

ETOH_BINGE

Yes

Char(1)

Y

FK

how often six or more drinks

0=never, 1= less than monthly, 2=monthly,3=weekly,4=daily, blank=not marked

MEDPROS/DMSS

6

DD2796_200801

174

EXP_ANIMAL_BITES

Yes

Char(1)

N

FK

Exposed to animal bites

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

175

EXP_ANIMAL_BODIES

Yes

Char(1)

N

FK

Exposed to animal bodies

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

176

EXP_CHLORINE

Yes

Char(1)

N

FK

Exposed to chlorine gas

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

177

EXP_URANIUM

Yes

Char(1)

N

FK

Exposted to depleted uranium

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

178

EXP_URANIUM_TEXT

Yes

Char(15)

Y

Explanation of exposure to depleted uranium

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

179

EXP_VIBRATION

Yes

Char(1)

N

FK

Exposed to excessive vibration

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

180

EXP_FOG_OILS

Yes

Char(1)

N

FK

Exposed to fog oils

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

181

EXP_GARBAGE

Yes

Char(1)

N

FK

Exposed to garbage

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

182

EXP_HUMAN_BODIES

Yes

Char(1)

N

FK

Exposed to human bodies

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

183

EXP_POLLUTION

Yes

Char(1)

N

FK

Exposed to industrial pollution

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

184

EXP_INSECT_BITES

Yes

Char(1)

N

FK

Exposed to insect bites

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

185

EXP_RADIATION

Yes

Char(1)

N

FK

Exposed to ionizing radiation

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

186

EXP_FUELS

Yes

Char(1)

N

FK

Exposed to JP8 or other fuels

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

187

EXP_LASER

Yes

Char(1)

N

FK

Exposed to lasers

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

188

EXP_NOISE

Yes

Char(1)

N

FK

Exposed to loud noises

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

189

EXP_PAINTS

Yes

Char(1)

N

FK

Exposed to paints

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

190

EXP_PEST_ENVIRO

Yes

Char(1)

N

FK

Exposed to environmental pesticides

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

191

EXP_MICROWAVE

Yes

Char(1)

N

FK

Exposed to radar/microwave

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

192

EXP_SAND

Yes

Char(1)

N

FK

Exposed to sand/dust

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

193

EXP_SMOKE_TRASH

Yes

Char(1)

N

FK

Exposed to smoke from burning trash or feces

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

194

EXP_SMOKE_OIL

Yes

Char(1)

N

FK

Exposed to smoke from oil fires

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

195

EXP_SOLVENTS

Yes

Char(1)

N

FK

Exposed to solvents

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

196

EXP_SMOKE_HEATER

Yes

Char(1)

N

FK

Exposed to tent heater smoke

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

197

EXP_FUMES_EXHAUST

Yes

Char(1)

N

FK

Exposed to vehicle or truch exhaust fumes

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

198

EXP_OTHER

Yes

Char(1)

N

FK

Other exposures

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

199

EXP_OTHER_TEXT

Yes

Char(15)

Y

Explanation of other exposures

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

200

EXP_IMMED_CARE

Yes

Char(1)

Y

FK

Were you exposed to any chemical or hazard requiring immediate care?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

201

DESTROYED_VEHICLES

Yes

Char(1)

Y

FK

Were you in or did you enter or closely inspect any destroyed military vehicles?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

202

CBR_AGENTS

Yes

Char(1)

Y

FK

Do you think you were exposed to any chemical, biological, or radiological warfare agents?

Y = YES, N = NO, Z = DON’T KNOW, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

203

CBR_AGENTS_TEXT

Yes

Char(75)

Y

If exposed, explain with date and location

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

204

LOCNAT

Yes

Char(1)

Y

FK

Indoor contact with local nationals

1=None,2=Minimal,3=Moderate,4=Extensive, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

205

FHP_DEET

Yes

Char(1)

Y

FK

Used during deployment - DEET

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

206

FHP_PEST_UNIFORM

Yes

Char(1)

Y

FK

Used during deployment - PESTICIDE TREATED UNIFORMS

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

207

FHP_EYE

Yes

Char(1)

Y

FK

Used during deployment - EYE PROTECTION

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

208

FHP_HEAR

Yes

Char(1)

Y

FK

Used during deployment - HEARING PROTECTION

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

209

FHP_RESP

Yes

Char(1)

Y

FK

Used during deployment - RESPIRATOR

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

210

FHP_MEDS_AWAKE

Yes

Char(1)

Y

FK

Used during deployment - AWAKE MEDS

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

211

FHP_MEDS_NBC

Yes

Char(1)

Y

FK

Used during deployment - NBC MEDS

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

212

FHP_MEDS_PB

Yes

Char(1)

Y

FK

Used during deployment - PYRIDOSTIGMINE

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

213

FHP_MEDS_MARK1

Yes

Char(1)

Y

FK

Used during deployment - NERVE AGENT ANTIDOTE

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

214

FHP_MEDS_CANA

Yes

Char(1)

Y

FK

Used during deployment - SEIZURE ANTIDOTE

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

215

FHP_NBC_MASK

Yes

Char(1)

Y

FK

Used during deployment - NBC MASK

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

216

FHP_MOPP

Yes

Char(1)

Y

FK

Used during deployment - MOPP

1=Daily,2=Most days,3=Some Days,4=never,5=not available,6=not required, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

217

VAC_SMALLPOX

Yes

Char(1)

N

FK

Received small pox vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

218

VAC_ANTHRAX

Yes

Char(1)

N

FK

Received anthrax vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

219

VAC_BOTULISM

Yes

Char(1)

N

FK

Received botulism vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

220

VAC_TYPHOID

Yes

Char(1)

N

FK

Received typhoid vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

221

VAC_MENING

Yes

Char(1)

N

FK

Received meningococcal vaccination just before or duing deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

222

VAC_YF

Yes

Char(1)

N

FK

Received typhoid vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

223

VAC_OTHER

Yes

Char(1)

N

FK

Received other vaccination just before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

224

VAC_OTHER_TEXT

Yes

Char(15)

Y

Explanation of other vaccination

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

225

VAC_NONE

Yes

Char(1)

N

FK

Received no vaccinations before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

226

VAC_DK

Yes

Char(1)

N

FK

Don't know if received any vaccinations before or during deployment

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

227

MEDS_MALARIA

Yes

Char(1)

Y

FK

Told to take malaria meds

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

228

MEDS_CHLORO

Yes

Char(1)

Y

FK

Took all chloroquine

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

229

MEDS_DOXY

Yes

Char(1)

Y

FK

Took all doxyxycline

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

230

MEDS_MEF

Yes

Char(1)

Y

FK

Took all mefloquine

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

231

MEDS_PRIM

Yes

Char(1)

Y

FK

Took all primaquine

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

232

MEDS_OTHER

Yes

Char(1)

Y

FK

Took all other antimalarial

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

233

MEDS_OTHER_TEXT

Yes

Char(15)

Y

Other antimalarial text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

234

REQ_PROVIDER

Yes

Char(1)

Y

FK

Would like to schedule healthcare visit

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

235

REQ_STRESS

Yes

Char(1)

Y

FK

Interested receiving info for stress

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

236

REQ_FAMILY

Yes

Char(1)

Y

FK

Interested in assistance with Family

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

237

REQ_CHAPLAIN

Yes

Char(1)

Y

FK

Interesrted in seeing Chaplain

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

238

MED_PROBLEMS

Yes

Char(1)

Y

FK

Do you have any medical or dental problems?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

239

MED_PROB_CURR

Yes

Char(1)

Y

FK

Do you have any CURRENT medical or dental problems?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

240

LIGHT_DUTY

Yes

Char(1)

Y

FK

Are your currently on a profile, or light duty, or are you undergoing a medical board?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

241

LIGHT_DUTY_TYPE

Yes

Char(1)

Y

FK

Reason for the profile

P=general physical,U=upper extremity,L=lower extremity,H=hearing,E=vision,S=psychiatric, blank - not answered

MEDPROS/DMSS

6

DD2796_200801

242

LIGHT_DUTY_DEPLOY

Yes

Char(1)

Y

FK

Condition due to injury or illness during deployment?

Y = YES, N = NO, X = NA, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

243

LIGHT_DUTY_PRIOR

Yes

Char(1)

Y

FK

Similar problems prior to deployment?

Y = YES, N = NO, X = NA, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

244

LIGHT_DUTY_INCR

Yes

Char(1)

Y

FK

Condition worsen during the deployment?

Y = YES, N = NO, X = NA, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

245

HURT_SELF

Yes

Char(1)

Y

FK

Over last month, thoughts that you would be better off dead or hurting yourself in some way.

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

246

HURT_SELF_FREQ

Yes

Char(1)

Y

FK

How often bothered by thoughts that you would be better off dead or hurting yourself in some way.

0 = A few days, 1 = More than half of the time, 2 = Nearly every day, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

247

LOSE_CONTROL

Yes

Char(1)

Y

FK

Thoughts or concerns about hurting or losing control with someone

Y = YES, N = NO, Z = UNSURE, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

248

CURRENT_RISK

Yes

Char(1)

Y

FK

Provider determined risk to hurt self/others

Y = YES, N = NO, Z = UNSURE, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

249

OUTCOME

Yes

Char(1)

Y

FK

Outcome of Assessment

0 = Immediate referral, 1 = Routine follow-up referral, 2 = Referral not indicated, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

250

SCREEN_ETOH

Yes

Char(1)

Y

FK

Alchohol screening result

0=no evidence, 1=Potential ETOH problem + Refer to PCM, 2= Potential ETOH problem No PCM referral, 3=Potential ETOH Problem and referral not checked, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

251

MENTAL_HEALTH

Yes

Char(1)

Y

FK

During the past year, have you sought counseling for your mental health?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

252

SCREEN_TBI

Yes

Char(1)

Y

FK

Traumatic brain injury risk

0=no evidence, 1=Potential TBI problem + Refer , 2= Potential TBI problem + No referral, 3=Potential TBI Problem + referral not checked, blank=TBI question not answered

MEDPROS/DMSS

6

DD2796_200801

253

SCREEN_TB

Yes

Char(1)

Y

FK

Tuberculosis risk

0=minimal, 1=increased +TST recommended, 2=increased + TST not recommended, 3=Increased risk+ TST not answered, blank=Not answered

MEDPROS/DMSS

6

DD2796_200801

254

SCREEN_DU

Yes

Char(1)

Y

FK

Depleted uranium risk

0=no evidence, 1=Potential DU problem + Refer , 2= Potential DU problem + No referral, 3=Potential DU Problem + referral not checked, blank=DU question not answered

MEDPROS/DMSS

6

DD2796_200801

255

EXPOSURE_CONCERNS

Yes

Char(1)

Y

FK

Do you concerns about possible exposures or events during this deployment that you feel may affect your health?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

256

EXP_CONCERNS_TEXT

Yes

Char(100)

Y

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

257

HEALTH_CONCERNS

Yes

Char(1)

Y

FK

Do you currently have any questions or concerns about your health?

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

258

HEALTH_CONCERNS_TEXT

Yes

Char(100)

Y

Please list your concerns

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

259

CON_PHYSICAL

Yes

Char(1)

Y

FK

Provider identified concern - PHYSICAL

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

260

CON_EXPOSURE

Yes

Char(1)

Y

FK

Provider identified concern - EXPOSURE

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

261

CON_ENVIRO

Yes

Char(1)

Y

FK

Provider identified concern - ENVIRONMENTAL

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

262

CON_OCC

Yes

Char(1)

Y

FK

Provider identified concern - OCCUPATIONAL

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

263

CON_COMBAT

Yes

Char(1)

Y

FK

Provider identified concern - COMBAT

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

264

CON_DEPRESSION

Yes

Char(1)

Y

FK

Provider identified concern - DEPRESION

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

265

CON_PTSD

Yes

Char(1)

Y

FK

Provider identified concern - PTSD

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

266

CON_ANGER

Yes

Char(1)

Y

FK

Provider identified concern - ANGER

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

267

CON_SUICIDE

Yes

Char(1)

Y

FK

Provider identified concern - SUICIDE

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

268

CON_FAMILY

Yes

Char(1)

Y

FK

Provider identified concern - FAMILY

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

269

CON_ETOH

Yes

Char(1)

Y

FK

Provider identified concern - ETOH

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

270

CON_OTHER

Yes

Char(1)

Y

FK

Provider identified concern - OTHER

0 = minor, 1 = major, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

271

CON_OTHER_TEXT

Yes

Char(15)

Y

Provider identified concerns other text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

272

CARE_PHYSICAL

Yes

Char(1)

Y

FK

Under care for PHYSICAL

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

273

CARE_EXPOSURE

Yes

Char(1)

Y

FK

Under care for EXP

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

274

CARE_ENVIRO

Yes

Char(1)

Y

FK

Under care for ENV

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

275

CARE_OCC

Yes

Char(1)

Y

FK

Under care for OCC

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

276

CARE_COMBAT

Yes

Char(1)

Y

FK

Under care for COMBAT

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

277

CARE_DEPRESSION

Yes

Char(1)

Y

FK

Under care for DEPRESSION

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

278

CARE_PTSD

Yes

Char(1)

Y

FK

Under care for PTSD

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

279

CARE_ANGER

Yes

Char(1)

Y

FK

Under care for ANGER

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

280

CARE_SUICIDE

Yes

Char(1)

Y

FK

Under care for SUICIDE

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

281

CARE_FAMILY

Yes

Char(1)

Y

FK

Under care for FAMILY

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

282

CARE_ETOH

Yes

Char(1)

Y

FK

Under care for ETOH

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

283

CARE_OTHER

Yes

Char(1)

Y

FK

Under care for OTHER

Y = YES, N = NO, blank=not checked

MEDPROS/DMSS

6

DD2796_200801

284

REFTIME_PRIMARY

Yes

Char(1)

Y

FK

Referral time - PRIMARY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

285

REFTIME_MENTAL_PRIMARY

Yes

Char(1)

Y

FK

Referral time - MENTAL PRIMARY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

286

REFTIME_MENTAL_SPECIAL

Yes

Char(1)

Y

FK

Referral time - MENTAL SPECIAL

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

287

REFTIME_AUDIOLOGY

Yes

Char(1)

Y

FK

Referral time - AUDIOLOGY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

288

REFTIME_CARDIAC

Yes

Char(1)

Y

FK

Referral time - CARDIAC

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

289

REFTIME_DENTAL

Yes

Char(1)

Y

FK

Referral time - DENTISTRY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

290

REFTIME_DERM

Yes

Char(1)

Y

FK

Referral time - DERMATOLOGIC

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

291

REFTIME_ENT

Yes

Char(1)

Y

FK

Referral time - ENT

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

292

REFTIME_GI

Yes

Char(1)

Y

FK

Referral time - GI

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

293

REFTIME_MED

Yes

Char(1)

Y

FK

Referral time - INTERNAL MEDICINE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

294

REFTIME_NEURO

Yes

Char(1)

Y

FK

Referral time - NEUROLOGY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

295

REFTIME_GYN

Yes

Char(1)

Y

FK

Referral tme - GYN

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

296

REFTIME_OPHTHAL

Yes

Char(1)

Y

FK

Referral time - OPHTHALMOLOGY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

297

REFTIME_OPTOMETRY

Yes

Char(1)

Y

FK

Referral time - OPTOMETRY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

298

REFTIME _ORTHO

Yes

Char(1)

Y

FK

Referral time - ORTHO

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

299

REFTIME_PULMONARY

Yes

Char(1)

Y

FK

Referral time - PULMONARY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

300

REFTIME_UROLOGY

Yes

Char(1)

Y

FK

Referral time - UROLOGY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

301

REFTIME_CASE

Yes

Char(1)

Y

FK

Referral time - CASE MANAGER

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

302

REFTIME_ABUSE

Yes

Char(1)

Y

FK

Referral time - SUBSTANCE ABUSE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

303

REFTIME_HEALTH_ED

Yes

Char(1)

Y

FK

Referral time - HEALTH EDUCATION

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

304

REFTIME_CHAPLAIN

Yes

Char(1)

Y

FK

Referral time - CHAPLAIN

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

305

REFTIME_FAMILY

Yes

Char(1)

Y

FK

Referral time - FAMILY

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

306

REFTIME_ONE_SOURCE

Yes

Char(1)

Y

FK

Referral time - MILITARY ONESOURCE

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

307

REFTIME_OTHER

Yes

Char(1)

Y

FK

Referral time - OTHER

0=within 24hrs,1=within 7 days, 2=within 30 days, blank=not answered

MEDPROS/DMSS

6

DD2796_200801

308

REF_OTHER_TEXT

Yes

Char(15)

Y

Referral other text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

309

REF_NONE

Yes

Char(1)

N

FK

No referral

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

310

PROVIDER_COMMENTS

Yes

Char(100)

Y

Comments

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

311

CERT_PROVIDER

Yes

Char(1)

N

FK

Provider's Signature

PROVIDER SIGNATURE, "Y", "N"

MEDPROS/DMSS

6

DD2796_200801

312

D_CERT_PROVIDER

Yes

Char(8)

N

FK

Provider's Signature Date

DATE PROVIDER SIGNS, YYYYMMDD FORMAT

MEDPROS/DMSS

6

DD2796_200801

313

ADMIN_MED_THREAT

Yes

Char(1)

N

FK

Medical threat debriefing completed

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

314

PROV_HEALTH_ED

Yes

Char(1)

N

FK

Provided information for health education

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

315

PROV_BENEFIT

Yes

Char(1)

N

FK

Provided information for benefits

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

316

PROV_APPT

Yes

Char(1)

N

FK

Provided information for appointment assistance

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

317

DECLINED_FORM

Yes

Char(1)

N

FK

Member declined to complete form

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

318

DECLINED_INTERVIEW

Yes

Char(1)

N

FK

Member declined interview

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

319

DECLINED_REFERRAL

Yes

Char(1)

N

FK

Member declined referral

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

320

PROV_LOD

Yes

Char(1)

N

FK

LOD

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

321

ADMIN_HIV_DRAW

Yes

Char(1)

N

FK

Post-Deployment serum specimen collected

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

322

PROV_OTHER

Yes

Char(1)

N

FK

Provided OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

323

PROV_OTHER_TEXT

Yes

Char(15)

Y

Provided OTHER_TEXT

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

324

SYS_MTF

Yes

Char(1)

N

FK

Referred to MTF

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

325

SYS_DIV

Yes

Char(1)

N

FK

Referred to Division/Line

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

326

SYS_VA

Yes

Char(1)

N

FK

Referred to VA

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

327

SYS_VET

Yes

Char(1)

N

FK

Referred to Vet

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

328

SYS_TRICARE

Yes

Char(1)

N

FK

Referred to TRICARE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

329

SYS_CONTRACT

Yes

Char(1)

N

FK

Referred to Contractor

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

330

SYS_CONTRACT_TEXT

Yes

Char(15)

Y

Referred to Contractor text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

331

SYS_CMNTY

Yes

Char(1)

N

FK

Referred to COMMUNITY

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

332

SYS_CMNTY_TEXT

Yes

Char(15)

N

Referred to COMMUNITY text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

333

SYS_OTHER

Yes

Char(1)

N

FK

Referred to OTHER

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

334

SYS_OTHER_TEXT

Yes

Char(15)

Y

Referred to OTHER text

TEXT FIELD

yes

MEDPROS/DMSS

6

DD2796_200801

335

SYS_NONE

Yes

Char(1)

N

FK

Referred to NONE

Y = CHECKED, N = NOT CHECKED

MEDPROS/DMSS

6

DD2796_200801

336

ENTRY_ZIP

Yes

Char(5)

N

FK

Zip code of location where form is filled out

NNNNN, optional